Esa Aromaa

Personal stigma and use of mental health services among people with depression in a general population in Finland

BackgroundA minority of people suffering from depression seek professional help for themselves. Stigmatizing attitudes are assumed to be one of the major barriers to help seeking but there is only limited evidence of this in large general population data sets. The aim of this study was to analyze the associations between mental health attitude statements and depression and their links to actual use of mental health services among those with depression.MethodsWe used a large cross-sectional data set from a Finnish population survey (N = 5160). Attitudes were measured by scales which measured the belief that people with depression are responsible for their illness and their recovery and attitudes towards antidepressants. Desire for social distance was measured by a scale and depression with the Composite International Diagnostic Interview Short Form (CIDI-SF) instrument. Use of mental health services was measured by self-report.ResultsOn the social discrimination scale, people with depression showed more social tolerance towards people with mental problems. They also carried more positive views about antidepressants. Among those with depression, users of mental health services, as compared to non-users, carried less desire for social distance to people with mental health problems and more positive views about the effects of antidepressants. More severe depression predicted more active use of services.ConclusionsAlthough stronger discriminative intentions can reduce the use of mental health services, this does not necessarily prevent professional service use if depression is serious and views about antidepressant medication are realistic.

Predictors of stigmatizing attitudes towards people with mental disorders in a general population in Finland.

Background: For planning effective and well-targeted initiatives to reduce stigma, we need to identify which factors are associated with stigmatizing of people with mental disorders. Aims: This study examined how well a combination of variables predicts stigmatizing attitudes and discrimination in a general population. Methods: A survey questionnaire was sent to 10,000 persons aged 15–80 years residing in western Finland. Attitudes were measured using a scale consisting of negative stereotypes about people with depression and stereotypical beliefs connected with mental problems, while discrimination was measured by a social distance scale. Predictors included demographic variables, mental health resources, personal experience of depression or psychological distress, knowing someone who suffers from mental health problems, and negative stereotypical beliefs. Results: Although 86% of the population thought that depression is a real medical condition, the majority of respondents believed that people with depression are responsible for their illness. Social discrimination was significantly associated with respondents’ age, gender, native language, sense of mastery, depression, stereotypical beliefs and familiarity with mental problems. Conclusions: The results suggest that the need to address stigma is higher among men, older people and those without familiarity with mental problems. When planning interventions to shape stereotypes, the need for change is highest among those with a low sense of life control and poor social networks. Direct interactions with persons who have mental problems may change the stereotypical beliefs and discriminative behaviour of those who do not have familiarity with mental problems.

Attitudes towards people with mental disorders: the psychometric characteristics of a Finnish questionnaire.

BackgroundThe prevalence of mental disorders, especially depression, increasingly creates concern for our mental, social and economic well-being. The public has insufficient knowledge about mental disorders and their treatment. A stigma is attached to mental disorders, which has a multifaceted impact on the lives of patients and their families. A Finnish general population survey studied knowledge of and attitudes towards mental health problems. This study examines the background dimensions of the attitude items used in the survey.MethodsAn eight-page health survey questionnaire with 16 items on attitudes to mental health and depression was sent to a randomly selected sample of 10,000 persons aged 15–80 years. The overall response rate was 55.2%. The data were submitted to a principal component analysis (PCA). Two components were extracted by means of this analysis and submitted to further reliability analyses as well as to a preliminary validity analysis.ResultsThe PCA identified four components: (1) depression is a matter of will, (2) mental problems have negative consequences, (3) one should be careful with antidepressants and (4) you never recover from mental problems.ConclusionThe internal consistencies of the first two components were sufficient to build dimension scales for future analyses. The extracted components fit consistently with the leading stigma theories and earlier studies measuring public attitudes.

Social capital and reported discrimination among people with depression in 15 European countries

PurposeSocial capital is a protective factor for mental health. People with depression are vulnerable to discrimination and its damaging impact. No previous studies have explored the link between social capital and experienced or anticipated discrimination in people with depression. This study aims to test the hypothesis that levels of self-reported discrimination in people with depression are inversely associated with social capital levels.MethodA total of 434 people with major depression recruited in outpatient settings across 15 European countries participated in the study. Multivariable regression was used to analyse relationships between discrimination and interpersonal and institutional trust, social support and social network.ResultsSignificant inverse association was found between discrimination and social capital in people with major depression. Specifically, people with higher levels of social capital were less likely to have elevated or substantially elevated levels of experienced discrimination.ConclusionsHigher level of social capital may be closely associated with lower level of experienced discrimination among patients with major depression. It is important to explore these associations more deeply and to establish possible directions of causality in order to identify interventions that may promote social capital and reduce discrimination. This may permit greater integration in society and more access to important life opportunities for people with depression.