Differences In Help-seeking Research Articles

The effectiveness and acceptability of culturally adapted cognitive behavioural therapy for traumatised refugees and asylum seekers: A systematic review

AbstractDespite the extent of traumatisation experienced by refugee groups, uptake of evidence‐based interventions such as cognitive behavioural therapy (CBT) remain low with high dropout rates. While this has been linked to cultural differences in help seeking and how illness is understood, little is known about how effective or acceptable cultural adaptations to CBT (CA‐CBT) are. Conduct a systematic review of the types of CA‐CBT delivered to refugee groups and evaluate their effectiveness and acceptability. We searched six databases for CA‐CBT delivered to refugee groups experiencing depression or post‐traumatic stress disorder (PTSD). Effectiveness was evaluated using both quantitative outcome measures and qualitative data. Dropout rates were collected as a proxy measure of acceptability. The types of cultural adaptations used were also described. Findings are presented using narrative synthesis. We include 13 studies that made cultural adaptations to the delivery format or content of CA‐CBT. Linguistic adaptations and including culturally relevant emotion regulation strategies were most common. Results showed significant decreases in PTSD symptom severity in all but one study, and significant decreases in depression outcomes across all studies. Dropout rates was nine percent among all participants. Findings from qualitative studies indicated reduced distress whereas cultural adaptation increased trust in treatment. There is initial evidence supporting the effectiveness and acceptability of CA‐CBT. However, more research is required to establish best practices for adapting CBT to different cultures. Methodologically rigorous tests are needed to determine if CA‐CBT effectively meets the needs of forcibly displaced populations.

Education as a Moderator of Help Seeking Behavior in Subjective Cognitive Decline.

Disparities in Alzheimer disease (AD) and differences in help seeking (HS) across sociodemographic groups warrant public health concern. Research addressing such disparities must shift toward the earliest clinical manifestations of AD to optimize diagnosis, intervention and care planning. Subjective cognitive decline (SCD), a risk state for AD, provides an important context in which to examine sociodemographic-related disparities in HS. One hundred sixty-seven cognitively healthy older adults (M age =73, M education =16) (26.4% Black, Asian, or "Other") completed SCD questionnaire, HS questions, and mood measures (depression and anxiety). Binary logistic adjusted regressions examined: (a) the association between SCD and HS; and (b) the extent to which education moderated the relationship between SCD and HS. SCD [b = 0.06, SE=0.13, P <0.001, odds ratio=1.06, 95% CI (1.03, 1.08)] and education [b=0.32, SE=0.09, P <0.001, odds ratio=1.37, 95% CI (1.15, 1.64)] were independently associated with HS, with significant interaction between education and SCD on HS [b=0.2, SE=0.01, P =0.01, odds ratio=1.02, 95% CI (1.00, 1.03)]. Findings elucidate the importance of tailoring SCD-related psychoeducational resources depending on educational background as a preliminary stepping-stone in encouraging HS among older adults who may be at particular risk for developing dementia.

Sex and gender differences in primary care help-seeking for common somatic symptoms: a longitudinal study

Objective Women are reported to consult general practitioners (GPs) more frequently than men. However, previous studies on sex differences in help-seeking behavior for somatic symptoms do not distinguish between sex and gender, do not account for sex differences in presented symptoms, and are frequently conducted in clinical settings, automatically excluding non-help seekers. Therefore, we aim to assess the independent associations of sex and gender with primary care help-seeking for somatic symptoms in the general population. Design and setting Records from the longitudinal population-based Lifelines Cohort Study were linked to routine electronic health records from GPs. Subjects Participants reporting new-onset common somatic symptoms. Main outcome measures Associations between sex and gender, operationalized via a novel gender-index, with primary care help-seeking for somatic symptoms and differences in the strength of the association between gender and help-seeking for somatic symptoms between women and men. Results Of 20,187 individuals with linked data, 8325 participants (67.5% female; mean age = 44.5 years [SD = 12.9]) reported at least one new-onset somatic symptom. Hereof, 255 (3.1%) consulted the GP within 6 weeks of symptom onset. Female sex was positively associated with consulting the GP (OR = 1.78; 95%CI = 1.13–2.80), whereas feminine gender was not (OR = 0.67; 95%CI = 0.39–1.16). The latter association did not differ in strength between men and women. More paid working days are negatively associated with help-seeking (OR = 0.95; 95%CI = 0.91–0.98). Conclusions The results suggest that female sex rather than feminine gender is associated with primary care help-seeking behavior for somatic symptoms. Nevertheless, clinicians should be aware that gender-related variables, such as mean paid working days, may be associated with help-seeking behavior.

Sex and gender differences in help-seeking of patients with somatic symptoms

Sex and gender differences in help-seeking of patients with somatic symptoms

Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19: a UK-wide qualitative interview study.

BackgroundCOVID-19 has led to rapid changes in healthcare delivery, raising concern that these changes may exacerbate existing inequalities in patient outcomes.AimTo understand how patients’ help-seeking experiences in primary care for colorectal cancer symptoms during COVID-19 were affected by their socioeconomic status (SES).Design and settingQualitative semi-structured interviews with males and females across the UK, recruited using purposive sampling by SES.MethodInterviews were carried out with 39 participants (20 higher SES; 19 lower SES) who contacted primary care about possible symptoms of colorectal cancer during COVID-19. Data were analysed using framework analysis followed by comparative thematic analysis to explore differences between groups.ResultsThree themes were identified with differences between SES groups: 1) how people decided to seek medical help through appraisal of symptoms; 2) how people navigated services; and 3) impact of COVID-19 on how patients interacted with healthcare professionals. The lower SES group expressed uncertainty appraising symptoms and navigating services (in terms of new processes resulting from COVID-19 and worries about infection). There was also potential for increased disparity in diagnosis and management, with other methods of getting in touch (for example, email or 111) taken up more readily by higher SES patients.ConclusionThe findings suggest that COVID-19 exacerbated disparities between higher and lower SES participants. This study raises awareness around challenges in help seeking in the context of the pandemic, which are likely to persist (post-COVID-19) as healthcare systems settle on new models of care (for example, digital). Recommendations are provided to reduce inequalities of care.

Inclusiveness of the Concept of Mental Disorder and Differences in Help-Seeking Between Asian and White Americans.

Ethnic and racial group differences in help-seeking are a barrier to the effective and equitable delivery of mental health services. Asian American populations demonstrate relatively low levels of help-seeking. Explanations for this effect typically point to elevated levels of stigma in these populations. An alternative explanation is that low help-seeking might also reflect holding a relatively circumscribed concept of mental disorder. Individuals and groups with less inclusive concepts of disorder may be less likely to identify problems as appropriate for mental health treatment. This study aimed to test whether group differences in the breadth of the mental disorder concept account for group differences in help-seeking attitudes. A sample of 212 American participants (102 Asian Americans and 110 White Americans) were assessed on personal stigma, help-seeking attitudes, and mental disorder concept breadth. Mediation analyses examined whether stigma and concept breadth mediated group differences in attitudes. Compared to White Americans, Asian Americans reported higher levels of stigma and narrower concepts of mental disorder, both of which were associated with less positive help-seeking attitudes. Stigma and concept breadth both partially mediated the group difference in attitudes. Theoretical and practical implications for mental health promotion and culturally sensitive clinical practices are explored.

Differences in mental health service use between urban and rural areas of Australia

ObjectiveTo examine differences in use of mental health services between residents of rural, regional, and metropolitan areas of Australia in a population‐based sample of adults who meet clinical criteria for a mental disorder.MethodParticipants in this study were drawn from the Assessing Mental Health survey, which included 2,374 participants who met criteria for one or more mental disorders or reported suicidal ideation in the past month. Rates of self‐reported use of specific services for mental health problems (doctor/general practitioner, social worker, hospital, psychologist, psychiatrist, or counsellor) were compared between areas of residence, with subsequent logistic regression analyses used to account for potential confounds for variations in service use.ResultsThere were no differences in overall rates of use of professional services for mental health problems. There were also no significant differences in help seeking from specific sources, with the exception of psychologists. People in rural areas were 26% less likely to report having sought help from a psychologist in the past year than those in metropolitan areas (18% vs. 24%). This discrepancy was not accounted for by stigma, but attenuated after adjustment for severity of psychological distress and demographic factors.ConclusionLittle evidence of differences in help seeking in rural Australia compared to urban centres was observed, with the important exception of psychological service use. Further research is needed to characterise disparities in quality and accessibility of care.

Distress, Impairment, and Racial/Ethnic Differences in Perceived Need for Mental Health Treatment in a Nationally Representative Sample

Objective To advance our understanding of racial/ethnic differences in help seeking for mental health conditions, this article tests whether differences in serious psychological distress or functional impairment account for racial/ethnic differences in perceived need for treatment. Method Data from the 2009–2014 National Survey of Drug Use and Health, a survey of a nationally representative sample of the U.S. population, were analyzed. Logistic regression models were used to test whether differences in psychological distress, assessed with the Kessler-6, or functional impairment, assessed with the WHO Disability Assessment Scale, account for racial/ethnic differences in perceived need for mental health treatment. Results Perceived need, psychological distress, and functional impairment all vary significantly across racial/ethnic groups; psychological distress is highest among Hispanics interviewed in English and lowest among Hispanics interviewed in Spanish, while functional impairment is highest among Non-Hispanic Whites and lowest among Hispanics interviewed in Spanish. Associations with perceived need vary across racial/ethnic groups for distress (X2 (5) = 22.14, p = .001), but not for impairment (X2 (5) = 8.73, p = .121). Associations between distress and perceived need are significantly weaker among Hispanics interviewed in Spanish than among Non-Hispanic Whites (OR = 1.13 vs. 1.08, p = .001). Differences across racial/ethnic groups in perceived need are sustained after adjustment for distress and impairment. Conclusions Differences in perceived need across racial/ethnic groups are not attributable to differences in distress and impairment. Heterogeneity in the relationships of psychological distress and functional impairment with perceived need for mental health treatment is related to language, a strong indicator of country of birth.

Race and gender differences in attitudes toward help seeking among marginalized young adults with mood disorders: A mixed-methods investigation.

Race and gender differences in help seeking are well-established; however, reasons for these differences are less clear. This study examined race and gender differences in two potential contributors-perceptions of illness and attitudes toward treatment-in a sample of marginalized young adults. Interviews were conducted with young adults (age 18-25) with prior involvement in public systems of care and mood disorder diagnoses (n = 60). A quantitative interview assessed illness perceptions and attitudes followed by a qualitative interview focused on perceptions of mental illness and treatment. Analyses examined quantitative differences across four race/gender subgroups-White women (n = 13), White men (n = 6), women of color (n = 27), and men of color (n = 14), then qualitative results were reviewed for a subset of cases (n = 30) to understand differences revealed in the quantitative analyses. Women of color had lower scores on illness understanding compared to other groups and men of color had lower scores on chronicity. Attitudes including propensity toward help seeking and stigma resistance were lowest in men of color, followed by women of color. Qualitative findings supported that men of color viewed their symptoms as less chronic and managed symptoms by changing their mindset rather than formal treatments. White participants talked more about their illnesses as chronic conditions and spoke more positively of treatment. Race/gender differences were identified, particularly in relation to views of mental illness and stigma. Messaging that highlights independence and strength in relation to managing symptoms may be particularly important for young people of color. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The effect of post-traumatic stress disorder on the risk of developing prescription opioid use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III

ObjectiveTo evaluate the effect of baseline post-traumatic stress disorder (PTSD) and each symptoms cluster on the risk of developing opioid use disorder (OUD) in those exposed to opioid painkillers and to assess the effect of comorbid PTSD and OUD on functioning, OUD severity, and treatment seeking compared with individuals with OUD only. MethodsWe obtained data from 4025 individuals exposed to opioid painkillers from the National Epidemiologic Survey on Alcohol and Related Conditions III. We matched individuals with baseline PTSD with individuals without PTSD on demographics, developmental background, family history, personalities, and exposure to stressful life events with propensity score methodology. We controlled for clinical diagnoses and other risk factors that may have occurred after PTSD onset. Quality of life was assessed with the SF-12; the number of diagnostic criteria met indicated OUD severity. ResultsBaseline PTSD predicted OUD after controlling for matching variables and other risk factors, including baseline mood/anxiety disorders and other substance use disorders (odds ratio[OR]: 1.58; 95% confidence interval[CI]: 1.14–2.17; p=0.02). Among individuals with PTSD, arousal/reactivity cluster predicted OUD. Individuals with comorbid PTSD and OUD had lower mean scores on the SF-12 scale and greater severity of OUD than individuals with OUD. There were no differences in help-seeking. ConclusionBaseline PTSD increases the risk of developing OUD after exposure to opioid painkillers. Clinicians should screen for PTSD diagnosis and arousal/reactivity symptoms prior to prescribing painkillers. Integrated treatments are strongly recommended for patients with this dual diagnosis.

Ethnic and Gender Differences in Help Seeking for Substance Disorders Among Black Americans.

This paper uses the National Survey of American Life (NSAL) to examine within group differences regarding help-seeking for substance disorders among a US sample of African American and Caribbean Black men and women. We examined ethnic and gender differences in the type of providers sought for substance disorder treatment, as well as reasons for avoiding treatment. Results indicate that overall, few ethnic differences exist; however, African Americans are more likely than Caribbean Blacks to seek help from human service professionals (including a religious or spiritual advisor) and from informal sources of treatment such as self-help groups. Black men with a substance disorder were more likely to see a psychiatrist than Black women. Findings regarding reasons for avoiding treatment suggest that there may be a need to provide better education about the utility of substance disorder treatment, even before problems reach a high level of severity.

SEX DIFFERENCES IN HELP SEEKING FOR MOOD AND ANXIETY DISORDERS IN THE NATIONAL COMORBIDITY SURVEY-REPLICATION.

Past research has consistently found that men are less likely to seek help for mental disorders than women. However, the reasons for this difference are not clear. This study explored whether sex differences in attitudes toward help seeking, perceived interference caused by mental disorders, and attending routine medical visits could explain sex differences in help seeking. Analyses focused on 1,963 participants who met DSM-IV diagnostic criteria for a 12-month mood or anxiety disorder in the National Comorbidity Survey-Replication (NCS-R). Multiple logistic regression analyses were conducted to examine sex differences in help seeking from different types of providers after adjusting for attitudes toward help seeking, perceived interference in functioning, attending routine medical visits, and sociodemographic factors. While men were less likely than women to seek help from health care providers, this difference was limited to seeking care from medical doctors and informal services. Men were as likely to seek help from mental health professionals as women. Men's lower likelihood of attending routine medical visits as compared with women partially explained the sex difference in help seeking from medical doctors. In contrast, attitudes toward help seeking did not explain much of the sex differences in help seeking from medical doctors. Efforts aimed at reducing attitudinal barriers toward treatment seeking for mental disorders may not effectively reduce the sex disparity in mental health help seeking. The results highlight the importance of encouraging men to attend routine medical visits, as medical doctors are a key gateway to mental health services.

'I Hate Generalising, But…'. Coaches’ Views on Differences in Treatment Style for Male and Female Clients

Men are generally more reluctant than women to seek psychological help, perhaps because of negative preconceptions about therapy. We interviewed 20 life coaches to find out whether they had seen gender differences in expectations and outcomes regarding coaching in their male and female clients. Analysis of the interviews, using the grounded theory method, revealed that although almost all coaches described gender differences in help seeking and treatment preferences in their clients, most coaches demonstrated ambivalence about describing such gender differences. Findings are discussed both in terms of cognitive dissonance theory, and in terms of the beta bias hindering the recognition of gender differences. These findings have implications for how coaches (and psychotherapists, psychologists etc) can improve the delivery of their therapy.

The association between normalising attributions and help-seeking for cancer alarm symptoms in the community: a cross-sectional survey

BackgroundAttribution of early symptoms to non-pathological factors such as age or diet (normalising) is often identified retrospectively by patients with cancer as an explanation for delay in presentation. However, there have been no community-based studies. We aimed to assess associations between normalising attributions and help-seeking in a community sample of patients reporting cancer alarm symptoms. MethodsA questionnaire was mailed to 4858 adults (≥50 years with no cancer diagnosis) through primary care, asking about symptom experience in the previous 3 months. Respondents were asked, within a longer symptom list, whether they had experienced any of ten cancer alarm symptoms in the previous 3 months. Follow-up questions addressed perceived cause (free text), with responses categorised into normalisation (age, external factors), non-cancer disease, psychological factors, cancer, or “don't know”. Blank responses were treated as missing and excluded from analyses. Respondents were asked whether they had consulted a doctor (yes or no). FindingsResponse rate was 35% (n=1724). Normalising was common for four symptoms: persistent cough or hoarseness (81/296, 27%), persistent change in bowel habit (88/216, 41%), persistent change in bladder habit (67/166, 40%), and change in the appearance of a mole (27/71, 38%). Age (ie, an effect of getting older) was a common attribution for all symptoms except persistent cough, which was often attributed to smoking. Change in diet was a common attribution for change in bowel habit, and sun exposure for change in a mole. Missing attribution data (n=280) ranged from 15% (n=53) for cough to 42% (n=51) for change in mole. Logistic regression showed that normalising attributions were associated with being less likely to having contacted a general practitioner for persistent cough (odds ratio 0·46, 95% CI 0·27–0·79), after controlling for demographic characteristics, and the same effect was observed across symptoms. No sex or socioeconomic differences in help-seeking were seen. InterpretationAttributing symptoms to normal everyday causes was associated with delayed help-seeking for four cancer alarm symptoms. Attributions such as smoking and sun exposure, which are themselves risk factors for cancer, were among the attributions that undermined help-seeking. The substantial proportion of missing data for the attribution item suggests some reluctance to complete open text responses. More research is needed into how people make help-seeking decisions. FundingThis work was supported by a Cancer Research UK Postdoctoral Fellowship grant (C33872/A13216) awarded to KLW.

Gender Differences in Help-Seeking and Supportive Dialogue During on-Line Game

Gender difference plays an important role of helping-seeking and supportive behavior while the players encounter win or lose situation that will affect the cooperation in the on-line game. Our research team developed a game called Strike Up, and used it to investigate the help-seeking and supportive behaviors displayed by children in the cooperative/competitive scenarios. In Strike Up, players must calculate numbers in a strategic fashion so that they can move their flags to the destination faster than their opponents. Game players’ help seeking and supportive types in on-line discussion were categorized by Kappa method and data was analyzed by Kappa method, then Chi-square test was employed to examine the gender difference in different types of dialogues. The discourse analysis indicated that boys exhibited used more negative semantics. Girls appeared to display a more communal or cooperative orientation, as they used more positive, socially supported language. At the beginning of the game, boy were less willing to seek help than girls, yet, at the end, as the pressure of the competition mounted, male players became more eager to find assistance from teammates and were seen to adopt more help-seeking behaviors. The results can be implicated to increase the competition in game design to foster the help-seeking and supportive social behavior.

Symptoms of Mental Health Problems: Children's and Adolescents' Understandings and Implications for Gender Differences in Help Seeking.

Amidst concerns that young people’s mental health is deteriorating, it is important to explore their understandings of symptoms of mental health problems and beliefs around help seeking. Drawing on focus group data from Scottish school pupils, we demonstrate how they understood symptoms of mental health problems and how their characterisations of these symptoms as ‘rare’ and ‘weird’ informed participants’ perceptions that peers, teachers and parents would respond to disclosure in stigmatising ways. Consequently, participants suggested that they would delay or avoid disclosing symptoms of mental health problems. We highlight subtle gender and age differences and outline implications for policy and practice.

Treatment Engagement: A Neglected Aspect in the Psychiatric Care of Suicidal Patients

Treatment Engagement: A Neglected Aspect in the Psychiatric Care of Suicidal Patients

How Black African and White British Women Perceive Depression and Help-Seeking: a Pilot Vignette Study

The detection of psychological problems of black African people has been found to be substantially lower, compared with white British and black Caribbean people. This may be due to differences in patients' perceptions of illness. Little research has been carried out on factors that may influence the help-seeking behaviour of black Africans. To assess differences in the perceptions of depression of black African and white British women that may influence lower detection and to investigate whether there are ethnic group differences in reasons for not seeking formal help. A short quantitative illness perception measure, the Brief Illness Perception Questionnaire (BIPQ), was used in a community survey, using a standard text vignette methodology to control for variations in previous experiences of depression. Responses from women who indicated that they would not seek formal help for depressive symptoms were qualitatively analyzed. Differences in perceptions of depression were found between black African (n = 73) and white British groups (n = 72) on five of the nine BIPQ dimensions. Black women were more likely to perceive depression to have less serious consequences; to be associated with fewer symptoms; to be less chronic; to be less amenable to treatment; and more frequently attributed depression to social factors. Over half the participants (n = 74) said they would not seek formal help for depressive symptoms. Six qualitative response categories emerged to explain non-consultation. The most common factor for both groups related to GP consultation difficulties. Significantly more white women cited preferring alternative help sources as a reason for non-consultation. The greater number of black women citing anti-medication beliefs was marginally significant. There were no differences between the ethnic groups in their use of the remaining three categories: illness characteristics; service constraints; and stigma/shame. Differing perceptions of depression among black and white women could help explain GPs' lower detection rates of depressive problems of black women. Differences in views about the formal help available may explain ethnic differences in help-seeking.

PW01-109 - Epidemiology and characteristics of suicidal behaviour in general population in Slovenia

ObjectivesTo study and to evaluate the mental health of the general population of Slovenia with a special emphasis on suicidal behaviour.MethodsThe representative sample consisted of 846 randomly selected adult Slovene inhabitants, chosen from a pool of telephone subscribers (N = 2433). Data were gathered by the means of a telephone interview using standardised measures (RSES, Questionnaire of social support, Sense of Mastery) on specific variables related to mental health and suicidal behaviour, e.g. presence of mental illness, use of psychotropic substances, self esteem, sense of mastery of life, social support, etc.Results10% of participants have had suicidal ideation, 2% have had a plan for a suicide attempt (in both cases statistically significantly more women) whereas only 1% of the respondents actually attempted suicide. Greater risk for suicide was found among divorced and single persons and those living in rural areas. More than half of suicidal individuals didn’t seek help for their problems anywhere and those who did, mostly turned to relatives and friends. We observed statistically significant differences in help seeking among men and women (the later asking for help more). Suicidal individuals reported of statistically significant smaller social network, of smaller emotional support, lower self-esteem and lower feelings of having control over their own lives when compared to non-suicidal individuals.ConclusionOur results accord with specific theories of risk factors (sociological, psychological, etc.) and bear potential for directions to be taken when tailoring suicide prevention strategies, in particular when addressing the general population.

Help Seeking and Perceived Need for Mental Health Care Among Individuals in Canada With Suicidal Behaviors

Help Seeking and Perceived Need for Mental Health Care Among Individuals in Canada With Suicidal Behaviors