Race-Ethnicity as a Predictor of Attitudes Toward Mental Health Treatment Seeking

Previous research on mental health disparities shows that persons from racial-ethnic minority groups have less access to mental health care, engage in less treatment, and receive poorer-quality treatment than non-Hispanic whites. Attitudes and beliefs about mental health treatment were examined to determine whether they contribute to these disparities. Data from the National Comorbidity Survey Replication (NCS-R) were analyzed to determine attitudes toward treatment-seeking behavior among people of non-Hispanic white, African-American, and Hispanic or Latino race-ethnicity. Additional sociodemographic variables were examined in relation to attitudes and beliefs toward treatment. African-American race-ethnicity was a significant independent predictor of greater reported willingness to seek treatment and lesser reported embarrassment if others found out about being in treatment. These findings persisted when analyses adjusted for socioeconomic variables. Hispanic or Latino race-ethnicity also was associated with an increased likelihood of willingness to seek professional help and lesser embarrassment if others found out, but these differences did not persist after adjustment for the effects of socioeconomic variables. Contrary to the initial hypothesis, African Americans and Hispanics or Latinos may have more positive attitudes toward mental health treatment seeking than non-Hispanic whites. To improve access to mental health services among racial-ethnic minority groups, it is crucial to better understand a broader array of individual-, provider-, and system-level factors that may create barriers to care.

Americans' Attitudes Toward Mental Health Treatment Seeking: 1990-2003

Back to table of contents Previous article Next article Professional NewsFull AccessStrategies in Antistigma Battle Appear to Be WorkingEve BenderEve BenderSearch for more papers by this authorPublished Online:15 Jun 2007https://doi.org/10.1176/pn.42.12.0008aSeeking treatment for mental health problems has become more acceptable since the early 1990s, according to a new study. The more positive attitudes toward treatment over time may have contributed to a growing demand for mental health services over recent years.Data comparing attitudes toward mental health treatment in two nationally representative surveys showed that 27.1 percent of those surveyed between 1990 and 1992 reported being “very comfortable” with talking to a professional about personal problems, compared with 32.4 percent of those surveyed between 2001 and 2003.The findings appeared in the May Psychiatric Services.Lead author Ramin Mojtabai, M.D., Ph.D., told Psychiatric News that although he couldn't draw any definitive conclusions about these findings, he believed that a number of changes in the mental health field may have shifted attitudes for the better. Mojtabai is a PGY-3 resident in psychiatry at Beth Israel Medical Center in New York.Throughout the 1990s there was an increase in direct-to-consumer marketing of antidepressants, he explained, and a surge in depression-prevention and suicide-screening programs. This may have had a positive effect on public attitudes toward treatment.To detect these trends in attitudes about mental illness, Mojtabai compared data from respondents to the 1990-1992 National Comorbidity Study (NCS) with those from the 2001-2003 NCS–Replication (NCS-R), both of which studied mental health problems and treatment in the United States.For the NCS, researchers interviewed 8,098 randomly selected people aged 15 to 54 in their homes. For the NCS-R 10 years later, they interviewed a separate, randomly selected sample of 9,282 adults over age 18 in their homes.Three questions generated responses on attitudes toward mental health treatment: Participants reported whether they would seek help for a serious emotional problem on a scale ranging from “probably” to“ definitely not,” the degree to which they were comfortable talking about personal problems to a professional, and the degree to which they would be embarrassed if their friends knew they were getting professional help for an emotional problem (see chart). Responses to these questions were categorized on a scale from 0 to 3, with higher scores indicating more positive attitudes toward treatment.Mojtabai found that 35.6 percent of respondents to the NCS reported that they would “definitely” go for professional help for a serious emotional problem, compared with 41.4 percent of NCS-R respondents. He also found that 33.7 percent of NCS respondents reported that they would not be embarrassed if friends knew about their getting professional help. This number jumped to 40.3 percent for respondents to the later survey.When Mojtabai analyzed the findings by age, he found that adults aged 18 to 34 in the NCS-R had more positive attitudes toward mental health treatment seeking than adults of the same age did in the original NCS. However, adults in the 35 to 54 age range showed little change in attitudes at the two time points.“Although attitudes toward mental health treatment seeking improved in all generations,” he said, “the improvement was greatest in the generation that was 15 to 24 years old in 1990 to 1992.” This may be because they had more exposure to public-information campaigns and other positive media messages about mental illness, Mojtabai speculated.Data based on logistical regression analyses of treatment-seeking attitudes showed that black participants were 56 percent more likely to have a positive attitude toward treatment than were whites.In addition, respondents with a history of mental health treatment were 68 times as likely to have a favorable attitude toward mental health treatment as those who didn't.Mojtabai said future research should explore what specific factors impact attitude toward mental health treatment. “We also need to examine the impact of attitudes on service use,” he noted.An abstract of “Americans' Attitudes Toward Mental Health Treatment Seeking: 1990-2003” is posted at<http://ps.psychiatryonline.org/cgi/content/full/58/5/642>.▪ ISSUES NewArchived

Measuring Trends in Mental Health Care Disparities, 2000 2004

Overrepresentation of Black Americans in Psychiatric Inpatient Care

Numerous studies have documented overrepresentation of the black population in psychiatric inpatient settings, but none have included certain important covariates or examined heterogeneity within the black population. After controlling for key social, demographic, and clinical factors, the investigators sought to determine whether blacks are overrepresented in inpatient psychiatric settings; they examined differences within the black population by separately examining the prevalence of inpatient treatment of African Americans and U.S.- and foreign-born Caribbean blacks. Secondary analysis was performed on data from two population-based household surveys, the National Survey of American Life (NSAL) and the National Comorbidity Survey Replication (NCS-R), which provided a population-based sample of 9,371 community-dwelling adults, including 3,570 African Americans, 1,621 blacks of Caribbean descent, and 4,180 non-Hispanic whites. Using logistic regression, the investigators estimated self-reported lifetime psychiatric hospitalization as a function of racial-ethnic background after controlling for sociodemographic differences and differences in lifetime counseling or therapy and psychiatric diagnosis. With controls for demographic and clinical factors, both African Americans (odds ratio [OR]=2.52, 95% confidence interval [CI]=1.91-3.33) and Caribbean blacks (OR=2.74, CI=1.98-3.82) had higher odds than whites of having a psychiatric hospitalization in their lifetime. U.S.-born Caribbean blacks had much higher odds of hospitalization (OR=5.47, CI=3.60-8.32) than whites, whereas the likelihood of hospitalization of foreign-born Caribbean blacks did not differ from that of whites (OR=.96, CI=.51-1.82). Disparities between blacks and whites in the prevalence of psychiatric inpatient treatment appear to be persistent, but global comparisons mask important heterogeneity within the black population.

This study examined the extent and correlates of perceived unmet need for treatment among individuals with depression in the U.S. general population. Analyses were based on a representative sample of 6,510 adult participants in the 2005 and 2006 National Surveys on Drug Use and Health who reported a major depressive episode in the past 12 months. A total of 3,568 (62.4%) participants had sought mental health treatment in the past 12 months, and 2,942 (37.6%) had not; 34.9% and 26.8% of these groups, respectively, reported unmet need for treatment. In both groups, older age was associated with a lower likelihood of reporting unmet need for treatment, whereas greater distress and impairment and higher education were associated with a greater likelihood of reporting unmet need. Among treatment seekers, treatment from general medical providers was associated with greater likelihood of unmet need, and more outpatient visits and insurance coverage for the full year were associated with a lower likelihood of unmet need. The most common reason for not seeking needed treatment was a concern about costs (cited as a reason by 46.0% of the total sample). Even though rates of treatment seeking have increased, many persons with major depression continue to experience unmet need for treatment, which in this study was mainly attributable to concerns about treatment costs.

Disproportionate Use of Psychiatric Emergency Services by African Americans

Mental health care among marginalized populations in the United States

This study assessed patterns of mental health service use among adolescents who had attempted suicide and examined factors associated with their service use at individual, family, and community levels. Bivariate and multiple logistic regression analyses were conducted with data from 877 adolescents aged 12-17 who had attempted suicide in the past 12 months and who participated in the 2000 National Household Survey on Drug Abuse. Of the 877 adolescents, less than half (45%) reported that they had used mental health services in the past 12 months. Adolescents from racial-ethnic minority groups were less likely than whites to receive inpatient or outpatient mental health treatment, even when the analyses controlled for other demographic, individual, and family and community characteristics. Poor self-perceived health and living in a single-parent family were associated with use of inpatient services. Female gender, higher family income, participation in extracurricular activities, and the presence of symptoms of anxiety or disruptive disorders were associated with use of outpatient services. Use of school-based mental health services was associated only with participation in extracurricular activities. The mental health service needs of suicidal adolescents, especially those from ethnic minority groups and lower-income families, too frequently remain unmet. Larger racial-ethnic disparities were found in use of inpatient and outpatient mental health services than in use of school-based services. Mental health services offered within school settings can reach suicidal adolescents who need services but may experience barriers to standard types of care.

This study examined recent trends in Americans' attitudes toward mental health treatment seeking and beliefs about the effectiveness of such treatment. Data on attitudes and beliefs from two representative surveys of the U.S. general population were compared. Samples included 5,388 participants from the National Comorbidity Survey (NCS) in 1990-1992 and 4,319 from the National Comorbidity Survey-Replication (NCS-R) in 2001-2003. Participants in the 2001-2003 survey were more willing than those in the 1990-1992 survey to seek professional help for mental health problems (41.4% reported that they would "definitely go" for professional help in 2001-2003, compared with 35.6% in 1990-1992). Participants in the more recent survey were also more comfortable talking with a professional about personal problems (32.4% in 2001-2003 reported feeling "very comfortable," compared with 27.1% in 1990-1992) and were less likely to say that they would be embarrassed if others found out about it (40.3% reported being "not at all embarrassed" in 2001-2003, compared with 33.7% in 1990-1992). Attitudes of younger participants improved more than attitudes of middle-aged participants. Public beliefs about the effectiveness of mental health treatment and the likelihood of recovery without treatment changed little across surveys. Mental health treatment seeking has become more acceptable over the past decade, and perceived stigma associated with it has declined. These changes in public attitudes have likely contributed to the growing demand for mental health services in the United States and will continue to do so in the coming years.

Treatment Seeking for Depression in Canada and the United States

Problem Distrust and socioeconomic barriers are widely recognized as contributors to disparities in the healthcare system, particularly as it relates to mental health care (Lindinger-Sternart, 2015; National Alliance on Mental Illness, n.d.). African Americans continually experience societal pressures to disassociate with African American culture and to assimilate into mainstream culture. Perhaps accessing mental health services via a counselor is an extension of that pressure. In this way, the traditional counseling model for mental health intervention is a culturally counterintuitive approach for developing mental health among African American men. Men are a subset of the African American community that tends to engage in mental health treatment at a significantly lower rate than the general population. Conversely, research suggests that their distress is as significant if not more so than that of majority groups (Mental Health America, n.d.; Roberson &amp; Fitzgerald, 1992; Snowden, 2012). Research shows that cultural and systematic factors drive the underuse of mental health services among African American men (particularly counseling). Community-based psychoeducation spread by community members may be a means of making mental health information more accessible to this population in culturally congruent and enfranchised ways. Method A quantitative, non-experimental survey design was employed to examine the relationship between 1) ethnic identity salience, 2) socioeconomic status (the exogenous variables), and 3) attitudes toward seeking mental health treatment (both endogenous and exogenous) as predictors of receptivity toward community-based psychoeducation (the dependent/endogenous variable) among African American men. ANOVA and Structural Equation Modeling were employed to consider the relationship between variables and the latent construct. Convenience sampling was used to recruit a nationally representative sample of 461 African American men from across the country through the employment of Qualtrics data collection servicer. Following data collection, data were screened and analyzed using SPSS and AMOS software programs to ensure valid interpretation. Results The results indicated that African American men are most receptive to discussing/receiving mental health information with counselors, friends, and family, and in the corresponding settings (in counseling, social settings, or at home, respectively). Receptivity in those settings had no significant difference, which conveys comparable openness to discussing/receiving mental health information (i.e., psychoeducation). Such findings are indicative of community-based psychoeducation as an alternative to counseling. Overall, respondents were somewhat receptive to a variety of identified settings/individuals; however, barbershops/barbers were the least preferred option for discussing/receiving mental health information. Further, the original structural equation model poorly fit the collected data, so it was adjusted as informed by theory and supported by the literature. The final, good-fitting model explained only 18% of the variance in the dependent variable though it yielded unique insight into the relationship of the variables. Ethnic Identity Salience and Socioeconomic Status were meaningful predictors of Receptivity to Community-based Psychoeducation. Help-seeking Propensity was the only assessed Attitude toward Seeking Mental Health Treatment that was meaningful in the empirical model. Conclusions The findings support the existing research that African American men are receptive to community-based psychoeducation when administered through the appropriate channels. Given issues with feasibility and access, community-based psychoeducation dispersed through families and friends at home and in social settings may be preferable to counseling as a means of increasing mental health literacy among the general U.S. population of African American men. Future studies should strive to conceptualize mental health intervention in culturally congruent ways, develop community-based intervention modalities, and study African Americans in novel exploratory ways to generate practical mental health advancement. They should also consider how the changing zeitgeist, individual attitudes, and meaningful personal relationships impact the discussion of mental health and utilization of services among African American men.

For gender-diverse (GD) college marching band (MB) artists, the risks for anxiety and depression may be higher as they navigate the demands and stressors associated with MB, college, and their gender identity. To examine the risks of anxiety and depression across GD MB artists and to explore their barriers and attitudes toward seeking mental health (MH) care. Cross-sectional study. Online survey. Seventy-eight GD individuals (transgender = 12, nonbinary = 66, age = 19 ± 1 years). A survey was used to assess demographics, anxiety risk using the State-Trait Anxiety Inventory, depression risk using the Center for Epidemiologic Studies Depression Scale, and barriers and attitudes using the Barriers Towards Seeking Help Checklist, the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form, and the Mental Help Seeking Attitudes Scale. We calculated descriptive statistics and univariate analyses to evaluate scores, risks, and differences between MH and receiving assistance. Participants had high state anxiety (mean = 52.0 ± 112.1), trait anxiety (mean = 55.2 ± 10.0), and symptoms of depression (mean = 30.4 ± 12.0) based on the State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale. Overall, 78.2% (n = 61 of 78) of GD MB artists were considered at risk for both state and trait anxiety and depression, and 18% (n = 11 of 61) did not seek help from an MH professional. These GD MB artists cited a lack of time (82.1%; n = 64 of 78) as the primary barrier to seeking professional help. The mean score on the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form for all GD artists was 19.5 ± 5.0, and the total score for the Mental Help Seeking Attitudes Scale was 47.8 ± 9.2, which indicated more favorable attitudes toward seeking professional help. We identified high rates of clinical symptoms for depression and anxiety among GD MB artists. The data are consistent with those from other minority populations and above the normative values for cisgender students. The lack of help-seeking behaviors in nearly 15% of at-risk participants highlights the need for specialized resources for GD patients and those participating in MB.

ABSTRACTAttitudes toward seeking mental health treatment are a major predictor of seeking such treatment. Rates of seeking mental health treatment for postpartum depression are low despite contacts with health-care providers and available treatment. This study examined factors associated with four dimensions of attitude toward seeking mental health treatment among Israeli women in the postpartum period. Women (N = 1,059) were recruited (June 2008–February 2009) from a medical center’s maternity department within the first two days following delivery and completed a sociodemographic survey and the Attitudes Toward Seeking Professional Psychological Help Scale. Low recognition of need for mental health treatment was associated with having a below average income and no personal and family depression history; low stigma tolerance was associated with being younger, having more children, and defining oneself as ultra-orthodox; low interpersonal openness was associated with having a below average income. Moreover, low confidence in mental health practitioners was associated with being younger and non-ultra-orthodox. Understanding which women are likely to score low on various dimensions of attitude can help target interventions for improving these factors, reducing barriers to receiving mental health treatment among specific groups of women. Research should continue to explore specific attitude dimensions among various populations.