The Burden Of Stigma In Help Seeking Essay

To prepare: Watch the TED Talk by Sangu Delle and then review the readings for this week. Focus on Delle’s examples illustrating Corrigan’s model about the stages of stigma and the hierarchy of disclosure. Consider Delle’s experience against that model.

Submit a 3-page paper that addresses the following:

Briefly explain Corrigan’s model of the stages of stigma and his recommendations and hierarchy about recovery.The Burden Of Stigma In Help Seeking Essay

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Explain whether Delle’s experience follows that model. Use specific examples to argue your perspective. If you agree, identify which stage of recovery Delle is in.

Analyze Delle’s reports about his own experiences with both types of stigma. Provide specific examples, and in your analysis consider the following questions:

Does one type of stigma predominate in his talk?
Which of Delle’s personal values or beliefs were challenged by his internalizations about his own illness and help-seeking?
What strengths does he exhibit?
What was the primary benefit of his diagnosis?
Do you think his experience would be different if his culture was different? Explain why or why not?
READING

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https://www.psychologytoday.com/blog/debunking-myths-the-mind/201005/the-dangers-self-diagnosis The Burden Of Stigma In Help Seeking Essay

Mental illness has wide-reaching effects on people’s education, employment, physical health, and relationships. Although many effective mental health interventions are available, people often do not seek out the care they need. In fact, in 2011, only 59.6% of individuals with a mental illness — including such conditions as anxiety, depression, schizophrenia, and bipolar disorder — reported receiving treatment.

In the second issue of Psychological Science in the Public Interest (Volume 15, Number 2), Patrick W. Corrigan (Illinois Institute of Technology), Benjamin G. Druss (Emory University), and Deborah A. Perlick (Mount Sinai Hospital) discuss the role of stigma in limiting access to care and in discouraging people from pursuing mental health treatment.

Commentary: Creating and Changing Public Policy to Reduce the Stigma of Mental Illness
By Former U. S. First Lady Rosalynn Carter, Rebecca Palpant Shimkets, and Thomas H. Bornemann, The Carter Center Mental Health Program The Burden Of Stigma In Help Seeking Essay

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From a public standpoint, stereotypes depicting people with mental illness as being dangerous, unpredictable, responsible for their illness, or generally incompetent can lead to active discrimination, such as excluding people with these conditions from employment and social or educational opportunities. In medical settings, negative stereotypes can make providers less likely to focus on the patient rather than the disease, endorse recovery as an outcome of care, or refer patients to needed consultations and follow-up services.

These displays of discrimination can become internalized, leading to the development of self-stigma: People with mental illness may begin to believe the negative thoughts expressed by others and, in turn, think of themselves as unable to recover, undeserving of care, dangerous, or responsible for their illnesses. This can lead them to feel shame, low self-esteem, and inability to accomplish their goals. Self-stigma can also lead to the development of the “why try” effect, whereby people believe that they are unable to recover and live normally so “why try?” To avoid being discriminated against, some people may also try to avoid being labeled as “mentally ill” by denying or hiding their problems and refusing to seek out care.The Burden Of Stigma In Help Seeking Essay

Structural stigma (i.e., stigma that is part of social and institutional policies and practices) presents additional large-scale barriers to mental care by undermining opportunities for people to seek help. A lack of parity between coverage for mental health and other health care, lack of funding for mental health research, and use of mental health history in legal proceedings, such as custody cases, all present structural reasons that people might not seek treatment.

Studies have shown that knowledge, culture, and social networks can influence the relationship between stigma and access to care. For example, myths about mental illness and its treatment can lead to the development of stigma and discriminatory practices. Cultural factors can influence the types of behaviors that are thought to violate social norms and the degree to which discrimination against people who display nonconformative behavior is accepted. Social networks, including family members, friends, and coworkers, can also have a big impact on people’s decisions to pursue treatment, serving either to enhance feelings of stigma or to encourage care seeking.

Because of the impact of knowledge, culture, and networks on people’s decisions to access care, many public-health and policy initiatives meant to encourage care usage have focused on educating people about mental health to combat harmful stereotypes related to illness and treatment. Addressing cultural barriers to care and including supportive networks in treatment plans can also encourage treatment.The Burden Of Stigma In Help Seeking Essay

At the structural level, legislation such as the Americans with Disabilities Act of 1990, the Mental Health Parity Act of 1996, the Medicare Improvements for Patients and Providers Act, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, and, most recently, the Affordable Care Act of 2010, have served to protect people with mental illness from discriminatory practices.

In a commentary accompanying this report, former U. S. First Lady Rosalynn Carter, along with Rebecca Palpant Shimkets and Thomas H. Bornemann of the Carter Center Mental Health Program, describe the challenges faced in trying to reduce the stigma of mental illness and increase access to care. The many legislative efforts spearheaded by the Carter Center have helped create or change public law to protect the rights of people with mental illness and ensure parity for mental health services. Although these laws often serve to force structural changes, the hope is that legislative efforts will eventually lead to true changes in attitudes toward mental illness.The Burden Of Stigma In Help Seeking Essay

Despite the Carter Center’s many successes, more work needs to be done. Integrative research that connects the mental health, public health, education, and primary care fields is necessary. The authors of this report and commentary believe that such integrative efforts can help build a strong network of systems and services that encourage access to care without the fear of discrimination or prejudice.

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Comments

NOT MOSES September 5, 2014
Will overcoming associated stigma produce meaningful results if the majority of “professional” care providers continue to be ineffective at best and incompetent at worst? Please. The field is full of flakes who need treatment as much or more than their clients / patients. I have been a CADC since the late ’80s, an MFT since the late ’90s, and a Psy.D. since the late ’00s. I have spent way too much time cleaning up messes made by others, many of whom graduated from waaaaaay less than ethical degree mills. Unless or until the “profession” catches up with the late Arthur Deikman et al, I don’t see this changing.The Burden Of Stigma In Help Seeking Essay

Reply

RON LEIFER September 6, 2014
why is there stihma about mental illness and not physical illness like diabetes? on my oponoion it is because mental illness is about behaviot and diabetes is not. we expect people to be able to control their behaviot but not their physical bodies

Reply

MOEREVERIE June 16, 2017
i dont see the psychological aspect of humans to be as important in the past since other things were of concern: shelter, predators, clans, etc. only now are we seeing the effects of a mind that hasn’t been able to grow at the same pace as the human’s physical ‘prowess’

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KAINA MARTINEZ February 7, 2018
The same behaviour is what may have lead to the physcal illness. We may not change our physical bodies
But,can alter them by our behaviours too. (By the way we eat, exercise if any or not)The Burden Of Stigma In Help Seeking Essay

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JANE MUZZEY June 8, 2018
Are you serious? Not all mental illness is irrational or violent. People with a mental illness are educated, kind, compassionate and you would not be able to distinguish them from anyone else. It is people like you who contribute to the stigma of mental illness, causing people to forgo treatment because of it; many end of taking their own lives. I guess that makes you feel good.

Reply

KATHERINE HEIZER June 13, 2018
Jane, you are so correct. I was diagnosed in 1996 with bipolar depression 1. Middle class kid from the seventies who was a very hyper child never a bad child or teenager. I could go on and on. Age 52 now and in a small town in Kentucky. Lived in California and so on but now back in my home state since 2010. Go to a VA hospital for treatment along with nerve damage of an olé sports injury due to running and unsuccessful surgeries. Stigma in 2018 of this disease in societies is just so out in left field. A lot of people are just so uneducated when it comes to this disease it’s ridiculous. It’s even in the medical professions at times. Sad but true. I just keep surviving surrounded my uneducated people with closed minds that assume they know me but do not nor of this disease it’s even in some medical instances I have experienced.The Burden Of Stigma In Help Seeking Essay Hopefully in the future for others and generations that are being diagnosed that these unfair stigmas stop. As long as I get more information, observe myself and others around me, keep educating myself on this illness, listen and really watch other people I can keep an intimate knowledge of who I am, how others perceive, and just keep moving on hopefully into my sixties with a better understanding of society misinformation and this disease that I didn’t know I had in the seventies in a small town in Ky. The shows on tv, some of the things I’ve read, even some of the doctors I’ve encountered are totally off on this disease and who I am. By the way some people like myself don’t nor ever abused drugs, never battled an alcohol addiction, and have endured wrong perceptions of who I am for ages. People’s misjudgments don’t bother me anymore like they used to. It’s them that are uneducated and misinformed because they assume and don’t ask questions. So anyway this olé Kentucky gal will just keep trying to hang in with a society that just doesn’t understand me and others. I finally accept it.

Approximately 11 million (4.8 percent) adults in the United States suffered
from serious mental illness in 2009 (Substance Abuse Mental Health Services
Administration, 2012; SAMHSA). Serious mental illness was defined as serious
functional impairment in all or any of the following domains: work, school, home,The Burden Of Stigma In Help Seeking Essay
community. In addition, approximately 45 million (19.9 percent) adults in the United
States suffered from any mental illness in 2009 (SAMHSA, 2012). Of those with
serious mental illness, 39.8 % have not received treatment and of those with any
mental illness, 62.1% have not received treatment. Given the empirically supported
treatments for various mental illnesses, the number of untreated individuals is a
pressing concern.
Kessler et al. (1994) reported that when the need was recognized, participants
faced the following barriers: situational barriers, such as inconvenience or being
unsure of where to seek care (52%), financial barriers (46%), and believing that
treatment is not effective (45%). Furthermore, 72% of those who fail to seek treatment
report wanting to take care of the problem on their own. Similar results were found for
adolescents; in one study only one third of adolescents suffering from a mental illness
received treatment (Merikangas et al., 2011). In addition, non-Hispanic Black and
Hispanic adolescents were less likely to receive treatment for mood and anxiety
disorders compared to White adolescents.
2
There are many individual, familial, and societal costs associated with
untreated mental illness, including lower educational attainment (Kessler, Foster,
Saunders, & Stang, 1995), loss of productivity at work (Adler et al., 2006; Kessler &
Frank, 1997), and the exacerbation of medical illness, such as heart disease, diabetes,
and hypertension (Katon & Ciechanowski, 2002). Yet the National Comorbidity Study
found that fewer than 40% of people with serious mental illness (defined by
impairment across DSM-IV diagnoses) receive treatment for serious mental illness
(Kessler et al., 1994). Although underutilization of mental health services may be a
widespread problem, it is particularly salient for racial/ethnic minorities. Research
indicates that mental health care disparities among ethnic minorities are prevalent and
they are a pressing issue to address (Miranda, Nakamura, & Bernal, 2003).
Acculturation and enculturation, family, collectivism and individualism,
stigma, cultural mistrust, help-seeking, religion and spirituality, and finally variability
in manifestation and interpretation of distress are key cultural variables in
understanding underutilization among ethnic minorities (Goldston et al., 2008).
Scheppers, van Dongen, Dekker, Geertzen, and Dekker (2006) reviewed 54 articles to
determine the barriers of using health services for ethnic minorities. Scheppers et al.The Burden Of Stigma In Help Seeking Essay
examined barriers at the patient (e.g., sex, ethnicity, SES), provider (e.g., sex, skills,
and attitudes), and system (e.g., policy, organizational factors) levels. The review
includes quantitative studies (n = 28), qualitative studies (n = 10), combined studies
(qualitative and quantitative; n = 6), and other studies (literature reviews and
published essays; n = 8). Due to the heterogeneity in the review studies, the authors
chose to identify barriers, but the barriers are not necessarily empirically tested.
3
Barriers at the individual level were identified as being young, unmarried, living in
disadvantaged neighborhoods (i.e., high crime rates), life style factors, such as an
unhealthy diet or substance use, and poor familial or social support. In addition, the
authors identified that ethnic minorities’ perception about symptoms and knowledge
of disease may be based on cultural values and these perceptions may result in
different presentations of symptoms, which may result in diagnosing difficulties.
Duration of stay in the United States had mixed results, with some studies indicating
that recent immigrants face greater barriers, while others do not indicate so. Low level
of acculturation (i.e., separation or marginalization) is viewed as a potential barrier to
seeking health services, with associated barriers such as being uninsured. Language
barriers represent difficulties potentially affecting patient confidence, ability to
express symptoms, providers’ ability to understand such symptoms, overreliance on
the family member, etc. The authors also identified other potential patient level
barriers, such as gender, ethnicity, education, SES, duration of stay (in the country),
language skills, health beliefs and attitudes (i.e., a holistic view of health, supernatural
beliefs, etc.), knowledge of health services, health insurance benefits, immigration
status, time availability, stress, availability and access to services, traditional remedies
(in delaying seeking health services), perceived illness and perceived cause both by
the individual and the family.
The present study examines a structural model predicting attitudes towards
mental health help-seeking, with acculturation and stress as predictors, and stigma as a
mediator. Additional analyses will examine these factors and group comparisons by
racial/ethnic group and gender.
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CHAPTER 2
REVIEW OF LITERATURE
Stigma
One of the key variables investigated in mental health utilization is stigma. In a
World Mental Health Survey, perceived stigma about mental illness was found to be a
worldwide phenomenon among individuals with common mental illness, particularly
comorbid depression and anxiety, suggesting that stigma of mental illness is not
limited to a particular cultural group and/or only to severe mental illness (Alonso et
al., 2008). Mental health stigma is described as a cognitive-behavioral process
manifested in three different ways: public stigma, personal stigma, and label
avoidance (Corrigan & Wassel, 2008). Public stigma is defined as negative stereotypes
about people with mental illness, such as perceiving them as dangerous and weak and
blaming them for their problems or perceiving them as childlike and in need of others
to take care of them. Self-stigma is defined as the internalization of public stigma
(Link, 1987). Self-stigma can have an effect on self-esteem, self-efficacy and result in
underachieving or in avoiding growth and independence altogether (Corrigan &
Wassel, 2008). Finally, label avoidance is when individuals who are suffering from
psychiatric conditions do not seek treatment so they are not labeled as mentally ill,
thereby escaping the prejudice and discrimination associated with public and selfstigma (Corrigan & Wassel, 2008). Label avoidance is not a variable of interest in the
current study since this study does not focus on a psychiatric sample. Another form of
stigma is personal stigma or personal attitudes towards mental illness (Griffiths,
Christensen, Jorm, Evans, & Groves, 2004). Personal stigma applies to those
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individuals who do not have mental illness or who are not yet aware of it, unlike selfstigma (Eisenberg, Downs, Golberstein, & Kivin, 2009). The first step in the stigma
cycle is awareness of public stigma, followed by the formation of personal stigma, and
then an evaluation of one’s own status of mental illness (Corrigan, Watson, & Barr,
2006).The Burden Of Stigma In Help Seeking Essay
Personal stigma has been negatively associated with help seeking indicators,
such as perceived need of medication or therapy and actual use of medication or
therapy, and also with nonprofessional support (Eisenberg, Marilyn, Ezra, & Zivin,
2009). However, Eisenberg et al. did not find a significant association between public
stigma and help seeking. In addition, higher self-stigma was found among students
who were male, younger, Asian, international, more religious, or from a low
socioeconomic status. Barney, Griffiths, Jorm, and Christensen (2006) did find a
significant and negative relationship between public stigma and help-seeking attitudes,
and between self-stigma and help-seeking attitudes. Furthermore, participants who
endorsed greater self-stigma towards seeking professional services were less likely to
actually seek services when followed up over a two month period, while participants
who had sought help reported significantly less self-stigma before seeking help
(Vogel, Wade, & Haake, 2006), indicating that stigma has predictive value in actual
use of professional services. Many studies have found empirical support for a
relationship between stigma and different aspects of treatment. In a clinical sample,
greater public stigma has been found to be associated with lower treatment adherence
(Sirey, et al., 2001a) and with premature termination (Sirey, et al., 2001b). In
addition, individuals with stigma of mental illness were less likely to seek or use
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mental health services (Kessler et al., 2001; Vogel, Wester, Wei, & Boysen, 2005).The
research on stigma suggests that the relationship between public stigma, personal
stigma, and self-stigma to help-seeking needs further elucidation. Further clarifying
these relationships can inform the development of stigma-reduction interventions,
thereby increasing mental health treatment utilization.
In addition, the Office of Surgeon General 2001 report indicates that minority
groups are disproportionately represented in homeless and incarcerated populations,
indicating more systemic issues unique to those groups. Although, Hispanics and NonHispanic Blacks were not found to have a greater lifetime risk for psychiatric disorders
compared to Non-Hispanic Whites; both groups tend to have more persistence in
disorders, particularly with mood disorders for Hispanics and mood and anxiety
disorders for Non-Hispanic blacks (Breslau, Kendler, Su, Gaxiola-Aguilar, & Kessler,
2005). Some potential reasons for disparities include socio-economic status, perceived
discrimination, and stress (Wang et al., 2005; Williams, Yu, Jackson, & Anderson,
1997). A factor in disparities could be that individuals from ethnic minorities may
perceive symptom severity differently (Okazaki, Kallivayalil, & Sue, 2002). Another
key variable in persistence of disorders may be the lower rate of treatment among
racial-ethnic minorities (Wang et al., 2005). In addition, ethnic minorities have
consistently been found to either delay seeking treatment until a condition is chronic,
being reluctant to using mental health services, and having poorer access to services
(USDHHS, 2001).

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In a study assessing stigma in an urban community college sample, African
Americans and Asians were found to have greater stigma towards mental illness than
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Whites; Latinos were found to have less stigma than Whites (Rao, Feinglass, &
Corrigan, 2007). Rao et al. proposed that these disparities were due to African
Americans having more negative attitudes toward mental illness compared to other
groups due to stressors, such as racism and other social inequalities; they did not
speculate on results for Asians or Latinos. In a qualitative study, acculturation,
difficulty accessing services, and stigma played a major role in being deterrents of
help-seeking behaviors among Chinese immigrants in New York City (Chung, 2010).The Burden Of Stigma In Help Seeking Essay
Among a clinical population of depressed older African Americans, high levels of
public and self-stigma were associated with not being in treatment and not having
positive attitudes towards treatment (Conner, 2010). Stigma was analyzed as a
mediator in a study assessing attitudes towards psychological counseling in college
aged South Asian and White students (Loya, Reddy, & Hinshaw, 2010). White
students were found to have more positive attitudes towards counseling than South
Asian students. In addition, increased self-stigma in South Asians partially mediated
and accounted for 32% of the difference in attitudes towards psychological services.
The authors indicate the need to study cultural variables such as acculturation and its
relationship to stigma and help-seeking attitudes.
In a qualitative study investigating panic disorder treatment of low-income
African Americans, it was found that concerns about social stigma and concerns about
confiding in others in the community, as well a dearth of information of panic
disorder, were indicated as personal reasons to not seek treatment. Similarly, at the
community level, participants demonstrated limited information about mental illness
and stigma against those who seek treatment or have symptoms as “weak” or
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“spiritually flawed,” and these perceptions were identified as deterrents in seeking
treatment (Johnson, Mills, DeLeon, Hartzema, & Haddad, 2009). Similarly, among
low-income depressed women, White participants were more likely to perceive a need
for care than black or Latina women, which was also found to decrease the likelihood
of expressing a need for help across all ethnic groups (Nadeem, Lange, & Miranda,
2009). An examination of the same dataset revealed that compared to US-born Whites,
Black and Latina women (both immigrant and US-born) were more likely to report
stigma concerns and were less likely to want treatment, with the exception of
immigrant Latinas who were more likely to want treatment compared to US-born
Whites. However, only perceived stigma was examined, and not self-stigma. Stigma
was found to be a treatment barrier for African Americans compared to Caucasians in
other research as well (Alvidrez, Snowden, & Kaiser, 2008; Snowden, 1998). Overall,
there appear to be differences in the stigma against seeking mental health services
across racial/ethnic groups.
Another factor explored within the context of stigma is gender. Stigma has
been theorized to explain the systemic differences, with males having a lower rate of
mental healthcare utilization (Wang et al., 2005). Male gender was positively
associated with stigma avoidance and mistrust/fear of the system (Ojeda &
Bergstresser, 2008). In the same study, it was found that White male status was
specifically significantly associated with stigma avoidance, mistrust/fear of the
system, and negative attitudes towards care compared to other racial/ethnic groups,
which is in contrast to the literature that racial/ethnic minorities display greater stigma.
These conflicting results stress the importance of examining the intersection of
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race/ethnicity and gender and its relationship to stigma of seeking mental health
treatment.
Together these different forms of stigma toward mental illness results in
delayed seeking of mental health services and treatment compliance, which can result
in negative long-term outcomes (Corrigan, 2004; Corrigan & Wassel, 2007). Although
stigma against seeking mental health services is a widespread problem among all
Americans, it is a particularly salient issue for racial/ethnic minorities where factors
such as language barriers, acculturation, and access to services may make stigma even
more salient (Gary, 2005). It has recently been theorized that ethnic minorities face
“double stigma,” where negative attitudes towards mental health treatment are
compounded by the negative attitudes (stereotypes) and discrimination that ethnic
minorities already face, thereby creating a delay in treatment seeking or aborted
treatment, resulting in greater morbidity and mortality (Gary, 2005). The present study
will assess three forms of stigma and examine it in group comparisons by gender and
ethnicity/race, as a predictor of several mental health variables, and as a mediating
variable in models of mental health help-seeking.
Acculturation
In psychology, acculturation is often studied at the individual level.
Acculturation occurs when groups of individuals from different culture are in contact,The Burden Of Stigma In Help Seeking Essay
with changes resulting in one or both of the cultures (Redfield, Linton, & Herskovits,
1936). A popular framework used to organize these changes is a bilinear model
proposed by Berry (1989), where an individual’s relationship with both the
mainstream culture and the culture of origin is considered. This model is in contrast to
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the unilinear model, which contends that an individual’s relationship to his/her
heritage culture (culture one is raised in or influenced by) is dependent on his/her
relationship to mainstream culture (culture of the dominant society where individual
resides). For example, if an individual strongly identifies with his/her heritage culture
then a unilinear model implies a low identification with the dominant culture. A
unilinear perspective assumes the loss of traditional values at the expense of accruing
dominant values or the choice to retain traditional values and not adapt dominant
values (Ryder, Alden, & Paulhus, 2000). The unilinear perspective has been critiqued
for not accurately allowing for the many possibilities of acculturation, specifically
biculturalism (For review, Miller, 2007; Rudmin, 2003, 2009). In contrast, Berry et al.
(1989) categorized acculturation into four different types: integration (high heritage,
high mainstream), assimilation (low heritage, high mainstream), separation (high
heritage, low mainstream), and marginalization (low heritage, low mainstream).
Integration is associated with lower psychopathology and marginalization is associated
with higher psychopathology (Berry, 2007).
Acculturation has been found to have a significant association in the following
areas of research: eating disorders (e.g., Jennings, Forbes, McDermott, & Hulse, 2006;
Soh et al., 2007), suicidality (e.g., Kennedy, Parhar, Samra, & Gorzalka, 2005; Lau,
Jernewall, Zane, & Myers, 2002;), risky behaviors (e.g., Schwartz et al, 2011),
personality factors, adjustment, and achievement (Suinn, 2010). Acculturation has
mostly been studied with immigrant populations from racial/ethnic backgrounds;
however it has also been investigated with US born racial/ethnic minorities, such as
African Americans (e.g., Obasi & Leong, 2010). The Burden Of Stigma In Help Seeking Essay
11
In addition, the literature on acculturation has found that acculturation is
significantly associated with the many different aspects of the therapy process. In
Asian American college students, a significantly positive correlation was found
between acculturation and students’ ratings of the counseling process (Wang & Kim,
2010). Among Chinese Americans, acculturation, among other cultural factors, was
found to be a significant predictor of attitudes towards seeking professional
psychological help (Tata & Leong, 1994). Furthermore, acculturation was related to
willingness to seek counseling in both Asian Americans (Atkinson & Gim, 1989) and
recent Greek and Italian immigrants (Ponterotto et al., 2001). In all these studies,
higher acculturation to US culture was positively related to attitudes towards
counseling or counselors.
Recently, acculturation and stigma have been investigated to help elucidate
their relationship to the underutilization of mental health treatment. Ting and Hwang
(2009) examined acculturation, stigma tolerance, and help-seeking attitudes. Stigma
tolerance is defined as being aware of the cultural group’s stigma. Low stigma
tolerance is indicated by being aware of and worried about the cultural group’s stigma
towards help-seeking. In contrast, high stigma tolerance is being aware of, but not
worried about the group’s stigma, if seeking help. These results indicate that the
culture of origin may influence one’s stigma towards help-seeking. The authors found
that acculturation (measured bilinearly) did not have a relationship with help-seeking
attitudes; however, stigma tolerance was predictive of help-seeking behaviors.
However, they note that the college sample in this study did not reflect low levels of
acculturation and there was not a varied distribution of acculturation. Given the
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relationship between acculturation and stigma, the current study will include a
measure of cultural stigma, defined as examining existing stigma items, from the
perspective of the participant on how he/she perceives his/her own community
perspective of mental health stigma.The Burden Of Stigma In Help Seeking Essay
Stress
Perceived discrimination and stress have been implicated in mental health
treatment seeking by racial/ethnic minorities (Wang et al., 2005; Williams, Yu,
Jackson, & Anderson, 1997). In addition, perceived discrimination has been associated
with mental and physical health problems (Lee et al., 2009; Mossakowski, 2003).
Specifically, perceived racism significantly predicted number of poor mental and
physical health days (Anderson, 2013). Gary (2005) posits that perceived
discrimination/stressors associated with race and the stigma associated with mental
health treatment contributes to decreased mental health seeking in ethnic minorities. In
the current study, perceived discrimination is measured by a questionnaire on racerelated stressors.
Additional Factors
Help-seeking behaviors have been linked to gender (Rickwood & Braithwaite,
1994; Galdas, Cheater, & Marshall, 2005), with men less likely to seek help than
women. Other key factors to consider are the history of mental health treatment
(Deane, Skogstad, & Williams, 1999; Vogel, Wester, Wei, Boysen, 2005), level of
distress, with less willingness to seek treatment at moderate levels of distress and
cultural factors (Hsu & Alden, 2008; Menke & Flynn, 2009), intentions and attitudes
towards mental help seeking (Bayer & Peay, 1997; Codd & Cohen, 2003; Vogel,
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Wester, Wei, Boysen, 2005). Help-seeking attitudes have been associated with actual
mental health treatment use and presence of mood disorder, (ten Have, de Graaf,
Ormel, Vilagut, Kovess, & Alonso, 2010) and positively correlated with level of
distress (Komiya, Good, & Sherrod, 2000). The present study will also investigate the
relationship among these key variables.
Overview of the Present Study
In summary, both acculturation and stigma have been associated with help
seeking attitudes, but they have been studied together only on a limited basis. Given
the mental health disparities facing racial/ethnic minorities and the greater disease
burden, it may be beneficial to explore both psychological factors, such as stigma and
cultural factors, such as acculturation and race-related stressors that may play a role in
barriers to care. The current study extends the literature by examining acculturation,
race-related stressors, self-stigma, public stigma, and attitudes in a comprehensive
structural model. The model will allow examination of mediators and moderators. In
particular, while decreased stress and acculturation to mainstream culture is expected
to predict more positive help-seeking attitudes, this relationship will be mediated by
stigma about mental health treatment, which will be associated with more negative
attitudes. All results should be interpreted in the context of systemic factors such as
access to care.The Burden Of Stigma In Help Seeking Essay
Research Hypotheses
• Hypothesis 1: In a comparison of the three structural models (Figures 1, 2,
and 3) for all participants, the full model (Figure 3) will be the best-fitting
model: the predictors of acculturation and stress will be directly related to
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the outcome variable of help-seeking attitudes, while stigma about mental
health treatment will also serve to mediate this relationship between
acculturation and help-seeking attitudes.
o Hypothesis 1a: Race-related stress will be a significant negative
predictor of help-seeking attitudes and a significant positive predictor
of stigma.
o Hypothesis 1b: Decreased identification with heritage culture and lower
identification with ethnic identity will be significant and positive
predictors of help-seeking attitudes.
o Hypothesis 1c: Decreased identification with heritage culture and lower
identification with ethnic identity will both be associated with
decreased stigma about mental health treatment; in all three models, the
direct pathway between acculturation and stigma is expected to be
significant and positive in direction.
o Hypothesis 1d: Stigma will be significantly and negatively related to
help-seeking attitudes.
• Hypothesis 2: For White participants, heritage and mainstream acculturation,
ethnic identity, and race-related stressors will not be significant predictors of
depression, anxiety, and stress nor of attitudes towards help seeking and/or
intentions towards seeking counseling. Cultural factors will not be significant
predictors of stigma. In addition, increased stigma (all types) will significantly
predict lower attitudes towards help seeking and lower intentions towards
seeking counseling. The Burden Of Stigma In Help Seeking Essay
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• Hypothesis 3: For Nonwhite participants, both decreased heritage and
mainstream acculturation, decreased ethnic identity and increased race-related
stressors will be significant predictors of increased depression, anxiety, and
stress, increased stigma (all types), and lower attitudes of help seeking and
lower intention of seeking counseling. In addition, increased stigma (all types)
will significantly predict lower attitudes towards help seeking and lower
intentions towards seeking counseling.  The Burden Of Stigma In Help Seeking Essay