Patrick J. Heath

Does self-stigma reduce the probability of seeking mental health information?

An important first step in seeking counseling may involve obtaining information about mental health concerns and treatment options. Researchers have suggested that some people may avoid such information because it is too threatening due to self-stigma and negative attitudes, but the link to actual help-seeking decisions has not been tested. Therefore, the purpose of the present study was to examine whether self-stigma and attitudes negatively impact decisions to seek information about mental health concerns and counseling. Probit regression models with 370 undergraduates showed that self-stigma negatively predicted decisions to seek both mental health and counseling information, with attitudes toward counseling mediating self-stigmas influence on these decisions. Among individuals experiencing higher levels of distress, the predicted probabilities of seeking mental health information (8.5%) and counseling information (8.4%) for those with high self-stigma were nearly half of those with low self-stigma (17.1% and 15.0%, respectively). This suggests that self-stigma may hinder initial decisions to seek mental health and counseling information, and implies the need for the development of early interventions designed to reduce help-seeking barriers.

Two is more valid than one: Examining the factor structure of the Self-Compassion Scale (SCS).

The Self-Compassion Scale (SCS; Neff, 2003a) is the most widely used measure of self-compassion. Self-compassion, as measured by the SCS, is robustly linked to psychological health (Macbeth & Gumley, 2012; Zessin, Dickhaüser, & Garbade, 2015). The SCS is currently understood as exhibiting a higher-order structure comprised of 6 first-order factors and 1 second-order general self-compassion factor. Recently, some researchers have questioned the internal validity of this 1-factor conceptualization, and posit that the SCS may instead be comprised of 2 general factors—self-compassion and self-coldness. The current paper provides an in-depth examination of the internal structure of the SCS using oblique, higher-order, and bifactor structural models in a sample of 1,115 college students. The bifactor model comprised of 2 general factors—self-compassion and self-coldness—and 6 specific factors demonstrated the best fit to the data. Results also indicated the Self-Coldness factor accounted for unique variance in depression, anxiety, and stress, whereas the Self-Compassion factor only accounted for unique variance in its association with depression, providing further evidence for the presence of 2 distinct factors. Results did not provide support for the 1-factor composition of self-compassion currently used in research. Implications for using, scoring, and interpreting the SCS are discussed.

Modeling Stigma, Help-Seeking Attitudes, and Intentions to Seek Behavioral Healthcare in a Clinical Military Sample

OBJECTIVE This study examined the relationship between public and self-stigma of seeking behavioral health services, and help-seeking attitudes and intent in a sample of active duty military personnel currently being assessed for traumatic brain injuries in a military health center. Although it has been suggested that many military personnel in need of care do not seek services due to concerns with stigma it is not fully clear what role different types of stigma play in the process. METHOD Using previously collected data from a clinical sample of 97 military personnel, we conducted path analyses to test the mediation effects of self-stigma on the relationship between public stigma and attitudes toward and intentions to seek behavioral health care. RESULTS In contrast to a model of military stigma but in line with research with civilian samples, results from this study indicate that self-stigma fully mediates the relationship between public stigma and help-seeking attitudes and intentions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These results indicate that programming aimed at increasing mental health care use in the military might best focus on reducing self-stigma associated with seeking mental health services.

Masculinity and barriers to seeking counseling: The buffering role of self-compassion.

Less than 1/3 of college men seek psychological help per year when experiencing mental health concerns. Many believe this is because socialized masculine norms are incongruent with help-seeking decisions. In line with this, adherence to masculine norms, like emotional control and self-reliance, is consistently linked to factors associated with lower use of counseling. Identifying constructs that buffer, or reduce, the relationship between masculine norm adherence and common barriers to seeking help, like help-seeking self-stigma and resistance to self-disclosing, could shed light on mechanisms through which effective interventions could be developed. As such, this study examined whether self-compassion, or the ability to show oneself kindness and understanding in the face of challenges, moderated the relationship between masculine norm adherence and both help-seeking self-stigma and the risks associated with self-disclosing to a counselor in a sample of 284 undergraduate men (Mage = 19.68, range = 18–30). Results indicate that self-compassion is associated with lower levels of help-seeking self-stigma and disclosure risks. Additionally, and perhaps more importantly, self-compassion buffered the relationship between overall masculine norm adherence and each of these barriers. Furthermore, when specific masculine norms were examined, self-compassion buffered the relationship between emotional control and disclosure risks. These results support the need for future research focused on the development and assessment of self-compassion based interventions aimed at decreasing the barriers undergraduate men experience toward seeking psychological help.

Stigma of Seeking Psychological Services: Examining College Students Across Ten Countries/Regions:

Stigma is an important barrier to seeking psychological services worldwide. Two types of stigma exist: public stigma and self-stigma. Scholars have argued that public stigma leads to self-stigma, and then self-stigma is the primary predictor of attitudes toward seeking psychological services. However, this assertion is largely limited to U.S. samples. The goal of this research was to provide a first step in understanding the relationship between public stigma, self-stigma, and attitudes toward seeking psychological services in international contexts (N = 3,276; Australia, Brazil, Canada, Hong Kong, Portugal, Romania, Taiwan, Turkey, United Arab Emirates, and United States). Using structural equation modeling, we found that self-stigma mediated the relationship between public stigma and attitudes toward seeking services among college students in each country and region. However, differences in path strengths emphasize the need to pay attention to the role of public and self-stigma on attitudes toward seeking psychological services throughout the world.

Help-Seeking Attitudes of United Arab Emirates Students Examining Loss of Face, Stigma, and Self-Disclosure

The psychological help-seeking patterns of college students in the United Arab Emirates (UAE) have only recently begun to be examined. Initial suggestions indicate that the majority of Emirati students treat help seeking from counselors as a last resort, which may be linked to aspects of Emirati culture including feared loss of societal face, stigma associated with seeking help, and discouragement of self-disclosure to individuals outside of the family. The relationship among fear of losing face, stigma, self-disclosure expectations (i.e., risks and benefits), and help-seeking attitudes was examined using structural equation modeling with 407 Emirati college students. Loss of face and stigma were related to self-disclosure expectations, which in turn were related to help-seeking attitudes. Gender differences were also examined with results indicating significant mean differences across all variables, as well as across two paths of the structural model. These findings are discussed within the cultural context of the UAE.

Self-Compassion Moderates the Relationship of Perceived Public and Anticipated Self-Stigma of Seeking Help.

Help-seeking stigma is considered a major barrier that keeps people from seeking out psychological help. Self-compassion, or the act of treating oneself with kindness and non-judgment, is a possible protective factor that could be associated with diminished stigma. However, this possibility has yet to be studied. The present research (N = 369) examined whether a self-compassionate attitude toward oneself reduced the tendency for individuals to internalize perceived public stigma associated with seeking psychological help. It was predicted that self-compassion would moderate the effect of perceived public stigma on anticipated self-stigma of seeking help. Multiple regression results supported this hypothesis; among individuals endorsing greater perceived public stigma, those with high self-compassion reported lower anticipated self-stigma compared with those with low self-compassion. This suggests that self-compassion may buffer the negative effects of perceived public stigma on anticipated self-stigma by providing psychological resilience. These findings have important implications for the development of novel and effective approaches for reducing the negative psychological impact of stigma.

Do self-compassion and self-coldness distinctly relate to distress and well-being? A theoretical model of self-relating.

The current research tested a theoretical model of self-relating that examined the unique relationships of self-compassion and self-coldness with distress and well-being. Self-coldness has recently been identified as theoretically distinct from self-compassion, rather than part of a unitary self-compassion construct. As such, the incremental value of self-compassion and self-coldness on clinically relevant outcomes is unclear. Therefore, the current research tested a theoretical model of the unique relationships of self-compassion and self-coldness and both distress and well-being among university students (N = 457) and community adults (N = 794), as well as interactions between these 2 constructs. Structural equation modeling results in both samples revealed that self-compassion was uniquely related to well-being (&bgr;s = .36–.43), whereas self-coldness was uniquely related to distress (&bgr;s = −.34) and well-being (&bgr;s = .65–.66). Consistent with the Theory of Social Mentalities, across samples self-compassion more strongly related to well-being, whereas self-coldness more strongly related to distress. Self-compassion did not demonstrate a unique direct relationship with distress, but it did buffer the relationship between self-coldness and distress in both samples and the relationship between self-coldness and well-being in the community sample. Overall, results suggest that clinicians would benefit from tailoring the use of self-compassion and self-coldness interventions. Implications for future research and practice are discussed.

Self-affirming values to increase student veterans’ intentions to seek counseling.

Student veterans experiencing mental health concerns could benefit from seeking counseling (Rudd, Goulding, & Bryan, 2011), though they often avoid these services. Self-affirmation interventions have been developed to increase openness to health-related behaviors (Sherman & Cohen, 2006), and may also help promote psychological help-seeking intentions. This study explored whether a self-affirmation intervention increased intentions to seek counseling in a sample of 74 student veterans who had not previously sought counseling services. Participants completed pretest (Time 1) measures of distress and help seeking (i.e., self-stigma, attitudes, and intentions to seek counseling). A week later (Time 2), participants completed one of two conditions: (1) a self-affirmation intervention before viewing a psychoeducational video and brochure or (2) only the psychoeducational video and brochure before completing the same help-seeking measures as Time 1. A week after the intervention (Time 3), participants again completed the help-seeking measures. A focused longitudinal mediation model was conducted, examining the effect of the self-affirmation experimental condition on help-seeking intentions. Compared with those in the psychoeducation-only group, student veterans who completed the self-affirmation intervention reported increased intentions to seek counseling both immediately postintervention (Time 2) and a week later (Time 3).

Stigma in help-seeking: the case of adolescents

ABSTRACT Stigma associated with seeking help has been found to be a key help-seeking barrier, however its role is less clear for: (a) adolescents, (b) groups outside the United States and (c) different types of therapy. This study addresses these omissions by examining the relationships between perceptions of public stigma of mental illness and the self-stigma of seeking help, and how they are related to help-seeking attitudes and intentions for both individual and group therapy among adolescents in Israel (N = 238). Path analysis confirmed that self-stigma of seeking help was negatively related to attitudes towards psychological help which was then positively related to intentions to seek help, across both individual and group therapy. Consistent with the only other study conducted in Israel, but contrasting research from other parts of the world, the relationship between perceptions of public stigma of mental illness and self-stigma of seeking help was not present for either individual or group therapy. However, perceptions of public stigma of mental illness were a direct negative predictor of help-seeking attitudes for group therapy. Overall, participants reported more negative perceptions of group therapy than individual therapy. These results have implications for future interventions to increase help-seeking behaviours for adolescents.