Joseph H. Hammer

“Boys don't cry”: Examination of the links between endorsement of masculine norms, self-stigma, and help-seeking attitudes for men from diverse backgrounds.

The role of conformity to dominant U.S. masculine norms as an antecedent to help-seeking attitudes in men has been established using convenience samples made up largely of college-age and European American males. However, the role of conformity to masculine norms on help-seeking attitudes for noncollege-age men or for men from diverse backgrounds is not well understood. To fill this gap in the literature, the present study examined the cross-cultural relevance of a mediational model of the relationships between conformity to dominant U.S. masculine norms and attitudes toward counseling through the mediator of self-stigma of seeking counseling for 4,773 men from both majority and nonmajority populations (race/ethnicity and sexual orientation). Structural equation modeling results showed that the model established using college males from majority groups (European American, heterosexual) may be applicable to a community sample of males from differing racial/ethnic groups and sexual orientations. However, some important differences in the presence and strengths of the relationships between conformity to dominant masculine norms and the other variables in the model were present across different racial/ethnic groups and sexual orientations. These findings suggest the need to pay specific theoretical and clinical attention to how conformity to dominant masculine norms and self-stigma are linked to unfavorable attitudes toward help seeking for these men, in order to encourage underserved mens help-seeking behavior.

Is stigma internalized? The longitudinal impact of public stigma on self-stigma.

Stigma is considered an important barrier to seeking mental health services. Two types of stigma exist: public stigma and self-stigma. Theoretically, it has been argued that public stigma leads to the development of self-stigma. However, the empirical support for this assertion is limited to cross-sectional data. Therefore, the goal of this research was to examine the relationship between public stigma and self-stigma over time. Perceptions of public and self-stigma were measured at Time 1 (T1) and then again 3 months later at Time 2 (T2). Using structural equation modeling, we conducted a cross-lag analysis of public stigma and self-stigma among a sample of 448 college students. Consistent with assertions that public stigma leads to the development of self-stigma, we found that public stigma at T1 predicted self-stigma at T2, whereas the converse was not true. These findings suggest that if self-stigma develops from public stigma, interventions could be developed to interrupt this process at the individual level and reduce or eliminate self-stigma despite perceptions of public stigma.

On the Receiving End: Discrimination toward the Non-Religious in the United States

The present study examines perceived discrimination faced by religious ‘nones’. After distinguishing between atheists, agnostics, and ‘nones’ who are deists or theists, we use nationally representative data from the 2008 American Religious Identification Survey (ARIS) to study the contexts in which these various types of religious ‘nones’ have reported experiencing discrimination. The strongest predictor of such discrimination was not theological atheism or agnosticism but self-identifying as an atheist or agnostic when asked what ones religion is. Context-specific predictors of discrimination are age, region of the country, rural versus urban location, parents’ religious identifications, educational attainment, ethnicity and race. Results are consistent with the view that people who hold more pronounced views are more likely to report discrimination.

Men’s Help Seeking for Depression: The Efficacy of a Male-Sensitive Brochure About Counseling

Although depression among men is becoming better understood, men still underuse counseling services. Hence, there is an important need for improved ways to reach out to depressed men. This study examined the efficacy of a male-sensitive brochure aimed toward improving attitudes about seeking counseling and reducing the self-stigma of seeking counseling among 1,397 depressed men who had not previously sought help for their depression. Results indicate that the male-sensitive brochure, which incorporated current knowledge from the psychology of men and masculinity and mental health marketing, improved participants’ attitudes and reduced their self-stigma toward counseling. Furthermore, the new brochure improved attitudes and reduced stigma to a greater degree than previously developed brochures. Implications for mental health marketing, practice, and research are discussed.

Disentangling self-stigma: are mental illness and help-seeking self-stigmas different?

Two established but disparate lines of research exist: studies examining the self-stigma associated with mental illness and studies examining the self-stigma associated with seeking psychological help. Whereas some researchers have implicitly treated these 2 constructs as synonymous, others have made the argument that they are theoretically and empirically distinct. To help clarify this debate, we examined in the present investigation the overlap and uniqueness of the self-stigmas associated with mental illness and with seeking psychological help. Data were collected from a sample of college undergraduates experiencing clinical levels of psychological distress (N = 217) and a second sample of community members with a self-reported history of mental illness (N = 324). Confirmatory factor analyses provide strong evidence for the factorial independence of the 2 types of self-stigma. Additionally, results of regression analyses in both samples suggest that the 2 self-stigmas uniquely predict variations in stigma-related constructs (i.e., shame, self-blame, and social inadequacy) and attitudes and intentions to seek help. Implications for researchers and clinicians interested in understanding stigma and enhancing mental health service utilization are discussed.

Extending Religion-Health Research to Secular Minorities: Issues and Concerns

Claims about religion’s beneficial effects on physical and psychological health have received substantial attention in popular media, but empirical support for these claims is mixed. Many of these claims are tenuous because they fail to address basic methodological issues relating to construct validity, sampling methods or analytical problems. A more conceptual problem has to do with the near universal lack of atheist control samples. While many studies include samples of individuals classified as “low spirituality” or religious “nones”, these groups are heterogeneous and contain only a fraction of members who would be considered truly secular. We illustrate the importance of including an atheist control group whenever possible in the religiosity/spirituality and health research and discuss areas for further investigation.

Assessing the utility of the willingness/prototype model in predicting help-seeking decisions.

Prior research on professional psychological help-seeking behavior has operated on the assumption that the decision to seek help is based on intentional and reasoned processes. However, research on the dual-process prototype/willingness model (PWM; Gerrard, Gibbons, Houlihan, Stock, & Pomery, 2008) suggests health-related decisions may also involve social reaction processes that influence ones spontaneous willingness (rather than planned intention) to seek help, given conducive circumstances. The present study used structural equation modeling to evaluate the ability of these 2 information-processing pathways (i.e., the reasoned pathway and the social reaction pathway) to predict help-seeking decisions among 182 college students currently experiencing clinical levels of psychological distress. Results indicated that when both pathways were modeled simultaneously, only the social reaction pathway independently accounted for significant variance in help-seeking decisions. These findings argue for the utility of the PWM framework in the context of professional psychological help seeking and hold implications for future counseling psychology research, prevention, and practice.

Cross-Cultural Validity of the Self-Stigma of Seeking Help (SSOSH) Scale: Examination Across Six Nations

Researchers have found that the stigma associated with seeking therapy--particularly self-stigma--can inhibit the use of psychological services. Yet, most of the research on self-stigma has been conducted in the United States. This is a considerable limitation, as the role of self-stigma in the help-seeking process may vary across cultural groups. However, to examine cross-cultural variations, researchers must first develop culturally valid scales. Therefore, this study examined scale validity and reliability of the widely used Self-Stigma of Seeking Help scale (SSOSH; Vogel, Wade, & Haake, 2006) across samples from 6 different countries (England, Greece, Israel, Taiwan, Turkey, and the United States). Specifically, we used a confirmatory factor analysis framework to conduct measurement invariance analysis and latent mean comparisons of the SSOSH across the 6 sampled countries. Overall, the results suggested that the SSOSH has a similar univariate structure across countries and is sufficiently invariant across countries to be used to explore cultural differences in the way that self-stigma relates to help-seeking behavior.

The Relationship Between Seclusion and Restraint Use and Childhood Abuse Among Psychiatric Inpatients

Seclusion and restraint (S/R) is a controversial topic in the field of psychiatry, due in part to the high rates of childhood physical and sexual abuse found among psychiatric inpatients. The trauma-informed care perspective suggests that the use of S/R with previously abused inpatients may result in retraumatization due to mental associations between childhood trauma and the experience during S/R. Thus, though one would expect to see efforts on the part of inpatient psychiatric facilities to limit S/R of previously abused inpatients, research suggests that trauma victims may be more likely to experience S/R. The current study sought to clarify this possibility by examining whether presence or absence and chronicity of childhood sexual and physical abuse differed among three groups of adult inpatients (N = 622) residing at a mid-Western state psychiatric hospital. These groups are empirically derived on the basis of dramatic differences in the patterning of their exposure to S/R over the course of hospitalization. Results of Chi-square and Kruskal—Wallis tests suggest that the classes did not significantly differ in presence or absence and chronicity of childhood sexual or physical abuse when male and female inpatients were analyzed separately. However, among the class of inpatients who experienced the most instances of S/R, 70% of the members have histories of childhood abuse. Implications for inpatients, clinicians, and policy makers are discussed.

Measuring spiritual fitness: Atheist military personnel, veterans, and civilians.

This study investigated the impact of transcendent item phrasing (i.e., phrasing which assumes the respondent believes in certain sacred or supernatural concepts) on the validity of the U.S. Army’s Comprehensive Soldier Fitness (CSF) program’s spiritual fitness scale when administered to atheist military personnel, veterans, and civilians. Results indicated that the inclusion of transcendent phrasing led to reduced concurrent validity for the spiritual fitness scale when administered to atheist military personnel and veterans, reduced concurrent and predictive validity when administered to atheists’ but not Christians’ spiritual fitness. Notably, the removal of transcendent phrasing actually led to increased concurrent validity for Christian respondents. Taken together, these findings suggest the Revised scale, which is composed of items that do not rely on transcendent phrasing, produces better psychometric outcomes for both atheist and Christian respondents. Implications for the CSF program and the measurement of spiritual fitness are addressed.