Janelle H. Cheung

How are perceived stigma, self-stigma, and self-reliance related to treatment-seeking? A three-path model.

OBJECTIVE Many college students may experience mental health problems but do not seek treatment from mental health professionals. The present study examined how perceived stigma and self-stigma toward seeking mental health treatment, as well as perceptions of self-reliance for coping with mental health problems, relate to college student treatment-seeking. METHOD In total, 246 students completed a self-report survey that included measures of perceived stigma and self-stigma for treatment-seeking, self-reliance for addressing mental health concerns, self-reported mental health problems, symptoms of depression and alcohol-related problems, attitudes toward treatment-seeking, and treatment-seeking behavior. RESULTS Regression analyses revealed that higher perceived stigma, self-stigma, and self-reliance were all related to a more negative attitude toward treatment-seeking. In a 3-path mediation model, bootstrapping results indicated an indirect effect where perceived stigma was related to attitude toward treatment-seeking and treatment-seeking behaviors through self-stigma and self-reliance. Specifically, higher perceived stigma was related to higher self-stigma, higher self-stigma was related to higher self-reliance, and higher self-reliance was associated with a more negative attitude toward treatment-seeking in the overall sample, and a decreased probability of having sought treatment among those who screened positive for a mental health problem. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Perceived stigma may influence whether or not college students seek treatment for mental health problems by potentially increasing stigmatizing attitudes toward themselves and increasing preferences for handling problems on their own. Researchers and practitioners are recommended to seek a better understanding of the complex treatment barriers to reduce stigma and facilitate treatment-seeking.

The Role of Different Stigma Perceptions in Treatment Seeking and Dropout Among Active Duty Military Personnel

OBJECTIVE Many military personnel with mental health problems do not seek treatment from mental health professionals, and if they do seek treatment, they drop out of treatment before receiving the recommended number of sessions. The present study examined the role of 4 different stigma perceptions on these outcomes: perceived stigma to career, perceived stigma of differential treatment, self-stigma from seeking treatment, and stigmatizing perceptions of soldiers who seek treatment. METHOD One thousand three hundred twenty-four active duty soldiers completed a self-report survey assessment that included measures of the 4 different stigma perceptions, indices of mental health symptoms, receipt of mental health treatment, and whether they had dropped out of treatment before it was completed. RESULTS Participants screening positive for a mental health problem reported higher scores on all 4 stigma perceptions. All 4 stigma perceptions were each associated with a reduced likelihood of treatment seeking when considered individually, but only stigmatizing beliefs about those who seek treatment were uniquely associated with treatment seeking. Perceived stigma for ones career and differential treatment from others, along with self-stigma from treatment seeking, were associated with an increased probability of dropping out of mental health treatment. Self-stigma from treatment seeking was the only unique predictor of dropout. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Different stigma perceptions were associated with treatment seeking and dropout. Further longitudinal research is needed to examine how stigma perceptions influence these important outcomes. Practitioners need to be aware of how different stigma perceptions can influence treatment seeking and potentially target stigma perceptions during treatment to prevent dropout.

Barriers and facilitators of mental health treatment-seeking in U.S active duty soldiers with sexual assault histories

Despite significant mental health needs among sexual assault (SA) victims in the military, little is known about treatment-seeking patterns or factors associated with service use. This study examined service use behavior, barriers, and facilitators of mental health treatment-seeking in an active duty sample of 927 U.S. Army soldiers with mental health problems. SA victims (n = 113) did not differ from non-victims on barriers or facilitators after adjusting for demographic and mental health variables, with stigma rated as the largest barrier. Most SA victims (87.6%) had sought informal support and 59.3% had sought formal treatment. One third of treatment-seekers had dropped out of treatment. Multivariate logistic regression analyses identified several correlates of treatment-seeking among SA victims: Black race (OR = 7.57), SA during the military (OR = 4.34), positive treatment beliefs (OR = 2.22), social support for treatment (OR = 2.14), self-reliance (OR = 0.47), and stigma towards treatment seekers (OR = 0.43). Mental health symptoms were not associated with treatment seeking. Findings suggested that treatment-facilitating interventions should focus on improving recognition of mental health symptoms, altering perceptions related to self-reliance, and reducing stigma. Interventions should also enlist support for treatment-seeking from unit members, leaders, and significant others.

Money Matters: Recommendations for Financial Stress Research in Occupational Health Psychology

Money is arguably the most important resource derived from work and the most important source of stress for contemporary employees. A substantial body of research supports the relationship between access to financial resources and health and well-being, both at individual and aggregated (e.g. national) levels of analysis. Yet, surprisingly little occupational health psychology research has paid attention to financial issues experienced specifically by those in the labour force. With these issues in mind, the overarching goal of the present paper was to address conceptual and measurement issues in the study of objective and subjective aspects of financial stress and review several assessment options available to occupational health psychology researchers for both aspects of financial stress. Where appropriate, we offer guidance to researchers about choices among various financial stress measures and identify issues that require further research attention. Copyright

Determinants of mental health treatment seeking among soldiers who recognize their problem: implications for high-risk occupations

ABSTRACT Although research has documented an increased risk of mental health problems among employees in high-stress occupations, little attention has been devoted to the process by which employees seek treatment for these problems. Using components of the Stages of Change Model (Prochaska & DiClemente, 1982), this study examined the correlates of considering and receiving treatment for such problems among active-duty military personnel in the U.S. Army. A multidimensional assessment of determinants of treatment seeking was administered to 1725 military personnel, along with measures of mental health symptoms and treatment seeking. These determinants were examined as predictors of considering and receiving treatment among a sub-sample of 466 personnel who recognized having a current mental health problem. Multinomial logistic regressions indicated that attitudes towards treatment and a preference for self-reliance distinguished those considering treatment from those who had not sought treatment. A larger number of factors distinguished soldiers considering treatment from those who had actually received treatment, with operational barriers and self-reliance being the strongest and unique correlates. The discussion focuses on the importance of what organizations can do to facilitate treatment seeking among employees in high-risk environments.

An Item-Response Theory Approach to Safety Climate Measurement: The Liberty Mutual Safety Climate Short Scales

Zohar and Lurias (2005) safety climate (SC) scale, measuring organization- and group- level SC each with 16 items, is widely used in research and practice. To improve the utility of the SC scale, we shortened the original full-length SC scales. Item response theory (IRT) analysis was conducted using a sample of 29,179 frontline workers from various industries. Based on graded response models, we shortened the original scales in two ways: (1) selecting items with above-average discriminating ability (i.e. offering more than 6.25% of the original total scale information), resulting in 8-item organization-level and 11-item group-level SC scales; and (2) selecting the most informative items that together retain at least 30% of original scale information, resulting in 4-item organization-level and 4-item group-level SC scales. All four shortened scales had acceptable reliability (≥0.89) and high correlations (≥0.95) with the original scale scores. The shortened scales will be valuable for academic research and practical survey implementation in improving occupational safety.

Soldier Recommendations for Improving Mental Health Treatment Seeking in the Military

ABSTRACT Despite the prevalence of mental health issues in the military, only a minority of personnel who experience problems seek treatment. The underutilization of mental health services continues to be an important topic that deserves attention from both science and practice. Two studies were conducted with active-duty soldiers to assess their recommendations for actions that can be taken by soldiers who are experiencing mental health problems, their peers, their leaders, mental health professionals, and the upper-level chain of command to facilitate mental health treatment seeking. In addition, we compiled their recommendations to raise awareness, reduce stigma, and improve attitudes toward mental health treatment.

Do Job Demands of Chinese Manufacturing Employees Predict Positive or Negative Outcomes? A Test of Competing Hypotheses

Karaseks job demands-control (JDC) model posits that job control can buffer against the harmful effects of demands experienced by employees. A large volume of JDC research has obtained support for the main effects of demands and control, but not the interactive effects. Recent research on the challenge-hindrance stressors framework, however, found that work stressors may not always be deleterious, suggesting alternative hypotheses about the effects of demands and control. The present study therefore examined competing hypotheses concerning the effects of job demands on occupational health outcomes. Using a sample of 316 employees in a Chinese manufacturing company, we found that, consistent with the challenge-hindrance framework, production demands were challenge stressors associated with favourable outcomes (i.e. job satisfaction and psychological well-being). In addition, results showed that the interactive role of job control depended on the nature of outcome variables. Future recommendations and implications of findings are discussed.

A systematic review of the safety climate intervention literature: Past trends and future directions.

Safety climate represents the meaningfulness of safety and how safety is valued in an organization. The contributions of safety climate to organizational safety have been well documented. There is a dearth of empirical research, however, on specific safety climate interventions and their effectiveness. The present study aims at examining the trend of safety climate interventions and offering compiled information for designing and implementing evidence-based safety climate interventions. Our literature search yielded 384 titles that were inspected by three examiners. Using a stepwise process that allowed for assessment of interobserver agreement, 19 full articles were selected and reviewed. Results showed that 10 out of the 19 articles (52.6%) were based on a quasi-experimental pre- and postintervention design, whereas 42.1% (n = 8) studies were based on a mixed-design approach (including both between- and within-subject design). All interventions in these 19 studies involved either safety-/health-related communication or education/training. Improvement of safety leadership was also a common component of safety climate interventions. According to the socio-technical systems classification of intervention strategies, all studies were categorized as interventions focusing on improving organizational and managerial structure as well as the personnel subsystem; four of them also aimed at improving technological aspects of work, and five of them aimed at improving the physical work subsystem. In general, a vast majority of the studies (89.5%, n = 17) showed a statistically significant improvement in safety climate across their organizations postintervention.

Unit training to increase support for military personnel with mental health problems

ABSTRACT The present study examined the effectiveness of training designed to increase support toward military personnel with mental health problems. Soldiers from two Battalions (N = 349) were randomly assigned by squad to receive the training (n = 179) or to a survey-only control group (n = 170). Soldiers completed survey assessments at baseline and three months later. Soldiers also completed an implicit association test assessing attitudes toward mental health treatment at the three-month follow-up. Results revealed that soldiers in the training condition reported an increase in supportive behaviours toward soldiers with mental health problems three months following the training, whereas there was no increase in soldiers assigned to the control group. Soldiers in the training condition were also marginally more likely to increase their own treatment seeking in the three months following the training. Discussion focuses on the importance of unit member support for military personnel with mental health problems and the implications for employees in other occupations characterised by the expectation for resilience.