Help-seeking Outcomes Research Articles

Interventions to Reduce Mental Health Stigma in Young People

Mental health stigma is a considerable barrier to help-seeking among young people. To systematically review and meta-analyze randomized clinical trials (RCTs) of interventions aimed at reducing mental health stigma in young people. Comprehensive searches were conducted in the CENTRAL, CINAHL, Embase, PubMed, and PsycINFO databases from inception to February 27, 2024. Search terms included "stigma," "mental health," "mental disorders," "adolescents," "youth," and "randomized controlled trial." Inclusion criteria encompassed RCTs involving interventions aimed at reducing mental health stigma among young people (aged 10-24 years). Studies had to report outcomes related to stigma or help-seeking behaviors. Exclusion criteria included grey literature and studies without results. Data were extracted independently by 7 authors (M.A.C., D.N., F.B., S.C., Á.I.L., J.C., V.M.) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed with the Cochrane risk-of-bias tool. Three-level multivariate meta-analyses were conducted to account for within-study correlations and to maximize data use. Standardized mean differences (SMDs) (Hedges g) and odds ratios (ORs) with 95% CIs were calculated. The data analysis was conducted from May 30 through July 4, 2024. Primary outcomes included stigma-related knowledge, attitudes, behaviors, and general stigma. Help-seeking outcomes were categorized into attitudes, intentions, and behaviors. Secondary outcomes included self-efficacy and empowerment. A total of 97 studies were included in the systematic review, representing 43 852 young people (mean [IQR] age, 18.7 [15.8-21.3] years; mean [IQR] females, 59.2% [49.4%-72.0%]), and 74 studies were included in 3-level multivariate meta-analyses. Significant short-term effect sizes were found for stigma-related knowledge (SMD, 0.66; 95% CI, 0.43-0.89), attitudes (SMD, 0.38; 95% CI, 0.20-0.56), behaviors (SMD, 0.29; 95% CI, 0.13-0.45), and general stigma (SMD, 0.20; 95% CI, 0.06-0.34) and for help-seeking attitudes (SMD, 0.18; 95% CI, 0.09-0.28) and intentions (SMD, 0.14; 95% CI, 0.07-0.21). Social contact interventions had a greater influence on stigma-related behaviors than did educational approaches. These findings suggest that interventions to reduce mental health stigma among youth are beneficial in the short term. Further high-quality RCTs with long-term follow-up are needed to better understand and enhance these interventions' outcomes.

Perceived Helpfulness of Formal and Informal Supports among Collegiate Survivors of Intimate Partner Violence

Purpose: Intimate partner violence (IPV) among college students is a serious public health problem. Seeking help after IPV victimization is critically important to reducing negative consequences of IPV. The literature suggests that help-seeking does not always result in positive outcomes. This study identified the predictors of help-seeking outcomes, with special attention given to various types of help sources. Methods: A cross-sectional online survey was conducted, with main variables being IPV victimization (physical, sexual, technological, psychological), help-seeking sources (seven formal, six informal) and outcomes (helpful or not), and depression. A series of logistic regression analyses were run with each source of help as the dependent variable. Results: Among formal help sources, social workers were the most helpful (89%), with police (51%) the least helpful. Among informal help sources, friends were the most helpful (81%), with partner’s family (46%) the least helpful. Logistic regression analysis results showed that medical help was less likely to be helpful for those who were male, depressed, or victimized by technological violence, and friends were less likely to be helpful for those who were sexual minority or depressed. Conclusion: Police being the least helpful among various help sources indicates a need for an in-depth look at how they interact with college student survivors. In medical care, male, depressed, or technologically victimized survivors may not receive a proper, sensitive care. Sexual minorities or depressed survivors found friends less helpful. Raising public awareness of less understood needs of various subgroups would help IPV survivors receive much needed help.

How are motivational interviewing techniques associated with US healthcare employees’ mental health help-seeking behaviours when using the interactive screening programme

IntroductionSuicide rates for healthcare workers, coupled with mental health challenges, continue to increase in the USA. This study aimed to assess how the Interactive Screening Programme (ISP) is being used...

Examining the Racial and Gendered Impacts of Police-Initiated Contacts on Help-Seeking

Abstract It is well known that marginalized communities of color, particularly young Black men, are more likely to experience police-initiated contact that other groups. Research suggests that these events contribute to legal cynicism, or the belief that the law and its agencies are ineffective, unwilling to help, and untrustworthy. In turn, cynical orientations limit one’s willingness to call the police to help. However, recent work on marginalized women suggests that despite holding cynical attitudes towards the police, their immediate needs for safety and services supersede these beliefs. The current study examines the racialized and gendered linkages between police-initiated contact and help-seeking outcomes (reporting crime, calling for an emergency, and seeking help from police for non-emergencies). Using data from the Police Public Contact Survey (from the Police Public Contact Survey–2020) results indicate that Black and Hispanic participants were less likely than White participants to seek help. However, Black and Hispanic women were more likely than their male counterparts for calls for help regarding a crime or disturbance. Across all outcomes, police-initiated contact was associated with higher rates of help-seeking. Perceived illegitimacy of street stops reduced the odds of reporting crimes to the police. However, perceived traffic stop illegitimacy was not related to help-seeking. Police initiated contacts and perceptions of legitimacy did not moderate the relationships between demographic variables and help-seeking outcomes. Implications for theories on legal socialization and the impact of police-initiated contacts on help-seeking are discussed.

Engaging Law Enforcement Employees in Mental Health Help-Seeking: Examining the Utilization of Interactive Screening Program and Motivational Interviewing Techniques.

The Interactive Screening Program (ISP) is an anonymous screening and dialogue platform used in workplaces to encourage mental health help-seeking. This study examined utilization of ISP among law enforcement workplaces and assessed how motivational interviewing techniques were associated with various help-seeking outcomes. This retrospective study used secondary ISP screening and dialogue data collected from 2013 to 2019 at four law enforcement workplaces or unions (N = 691). Independent variables include counselors' use of motivational interviewing techniques in their dialogue such as asking questions and showing empathy in their response. Help-seeking outcomes include requesting a referral, making a commitment to counseling services, decreased ambivalence about mental health services, and increased willingness to seek future services. Two-thirds of participants screened within the high distress level of ISP. Among them, 53% responded to the counselor's initial email and 50% of those who responded requested a referral for future services. Binary logistic regression models showed that counselors' use of confrontation in the dialogue was associated with improved willingness to seek services among ISP users (OR = 2.88, 95% CI = 1.24, 6.64). Further, ISP users who accessed ISP through their workplace peer support program, as compared to their employee assistance program (EAP), are more likely to show decreased ambivalence about seeking future services over time (OR = 0.28, 95% CI = 0.09, 0.80). This study demonstrates that the anonymous ISP program can successfully engage employees with high distress levels, including employees with suicidal ideation. Results highlight the importance of customizing ISP counselors' responses to be responsive for law enforcement employees.

Increasing Help-Seeking Intentions for Mental Health Difficulties in Early Adolescence: The Role of Cumulative Promotive Factors

Despite evidence to suggest that receiving support for mental health difficulties can improve later outcomes, adolescents often do not seek help when needed. While factors that reduce the likelihood of help-seeking intentions are well established, little is known about the factors that may increase adolescents’ intentions to seek help. This study sought to identify promotive factors for general help-seeking intentions, as well as help-seeking intentions from formal and informal sources specifically, and to test the assumptions of cumulative promotion theory in relation to help-seeking. Participants comprised 290 early adolescents (aged 11–14) in Northwest England who completed a suite of online measures assessing their mental health, wellbeing, and help-seeking intentions. Candidate promotive factors were modelled, and a cumulative promotive index (CPI) score was generated for each participant. Hierarchical regression was used to analyse the data. A range of promotive factors were identified for help-seeking intentions. CPI scores were significant predictors of all three help-seeking outcomes, even after accounting for the variance explained by the individual promotive factors. Thus, this study confirms two key tenets of cumulative promotion theory in relation to help-seeking intentions amongst adolescents: (1) as the number of promotive factors increases, intentions to seek help for mental health difficulties also increase, and (2) the number of promotive factors is more important than their nature when increasing help-seeking intentions.

The effect of web-based educational interventions on mental health literacy, stigma and help-seeking intentions/attitudes in young people: systematic review and meta-analysis

ObjectivesThis study aims to provide a systematic review and meta-analysis of the literature on The Effect of Web-Based Educational Interventions on Mental Health Literacy, Stigma and Help-seeking intentions/attitudes in young people.MethodsArticles in English published between April 1975 and February 2023 were retrieved from seven databases, leading to a total of 2023 articles identified.Results20 studies were included after applying exclusion criteria, 10 of which were eligible for meta-analysis. Results showed that web-based educational interventions had a significant positive effect on mental health literacy knowledge (SMD = 0.70, 95% CI = [0.16, 1.25]), but not on stigma (SMD = -0.20, 95% CI = [-0.48, 0.08]) or help-seeking intentions/attitudes (SMD = 0.48, 95% CI = [-0.50, 1.46]).ConclusionThis study reviewed and analyzed the effect of web-based educational interventions on mental health literacy, stigma, and help-seeking intentions/attitudes among young people. The results showed that web-based educational interventions improved mental health literacy knowledge, but not stigma or help-seeking outcomes. The study suggested several recommendations to enhance the effectiveness of web-based educational interventions on stigma and help-seeking outcomes, such as using more rigorous designs and methods, more comprehensive and multifaceted interventions, more tailored and targeted interventions, and more collaborative and participatory approaches. The study concluded that web-based educational interventions may have a greater impact on reducing stigma and promoting help-seeking among young people, which may ultimately lead to better mental health outcomes and well-being for this population.

Emotion self-stigma as a unique predictor of help-seeking intentions: A comparative analysis of early adolescents and young adults.

There has been limited consideration of the role emotion self-stigma (i.e. beliefs that experiencing and expressing so called 'negative' emotions are unacceptable) may play in help-seeking for emotional distress. This study is the first to investigate whether emotion self-stigma uniquely predicts help-seeking intentions across two key emotion vulnerability periods in development: (a) early adolescence and (b) young adulthood. Cross-sectional data were collected from secondary school (n = 510; M age = 13.96 years) and university students (n = 473; M age = 19.19 years) residing in Australia. Both samples completed measures online examining demographic characteristics, emotional competence, mental health and help-seeking stigma, emotion self-stigma, and help-seeking intentions. The Data were analysed using hierarchical multiple regression. Emotion self-stigma was a significant unique predictor of help-seeking intentions in young adults but not adolescents. The strength of the relationship between increased emotion self-stigma and lowered help-seeking intentions was similar for both males and females, regardless of developmental period. Addressing emotion self-stigma alongside mental illness and help-seeking stigma may be useful to improve help-seeking outcomes, particularly as young people transition into early adulthood.

'Me' vs. 'Them': How Mental Illness Stigma Influences Adolescent Help-Seeking Behaviors for Oneself and Recommendations for Peers.

Mental illness stigma is a significant barrier to utilizing mental health services for young populations. Few studies have evaluated how specific stigma dimensions relate to help-seeking and recommendations among adolescents. We examined how the stigma dimensions of labeling, stereotypes, and separation/discrimination influenced self-reported help-seeking behaviors of adolescents and recommendations for hypothetical peers with a mental health problem. Longitudinal data (four assessments) from a study evaluating the effectiveness of three anti-stigma interventions (curriculum, contact, materials, versus control) among adolescents were analyzed (n=396). Help-seeking outcomes comprised services in formal (e.g., doctor), informal (e.g., friend), or school-based (e.g., school counselor) settings. Generalized estimating equations tested associations of labeling, stereotypes, and separation/discrimination on help-seeking for a personal problem and recommendations for vignette characters described as having bipolar depression or social anxiety disorder. Adolescents were more likely to make help-seeking recommendations for peers with mental health problems than they were to seek help for a problem of their own. Labeling was a strong predictor of self-reported help-seeking and recommendations. Mental health literacy, an indicator for low negative stereotypes, was related to increased recommendations but not self-reported help-seeking. Positive stigma action and awareness-high cognizance of stigma and how to engage in proactive behaviors towards treating and destigmatizing mental illness-increased help-seeking in formal and informal settings for oneself. Finally, separation/discrimination did not prevent self-reported help-seeking, but it did increase peer recommendations in certain settings. Stigma did not always influence or interfere with help-seeking in the same way when the help-seeker was oneself versus a peer.

Effectiveness of a multi-modal hospital-wide doctor mental health and wellness intervention

BackgroundDoctors report high rates of workplace stress and are at increased risk of mental health disorders. However, there are few real-world studies evaluating the effectiveness of interventions aimed at addressing workplace risk factors and improving doctors’ mental health in a hospital setting. This study was conducted over two years (2017–2019) to assess the effects of a multi-modal intervention on working conditions doctors’ mental health and help-seeking for mental health problems in two Australian teaching hospitals.MethodsThe multimodal intervention consisted of organisational changes, such as reducing unrostered overtime, as well as strategies for individual doctors, such as mental health training programs. Hospital-based doctors at all career stages were eligible to participate in two cross-sectional surveys. 279 doctors completed the baseline survey (19.2% response rate) and 344 doctors completed the follow-up survey (31.3% response rate). A range of workplace risk and protective factors, mental health (psychological distress and suicidal ideation) and help-seeking outcomes were assessed.ResultsThere were significant improvements in key workplace protective factors, with small effects found for doctors’ job satisfaction, stress, work-life balance and perceived workplace support and a significant reduction in workplace risk factors including a moderate reduction in reported bullying behaviour between baseline to follow-up (job satisfaction p < 0.05, all other outcomes p < 0.01). However, no significant changes in doctors’ mental health or help-seeking outcomes were found over the intervention period.ConclusionFollowing the implementation of individual and organisational-level strategies in two Australian tertiary hospitals, doctors reported a reduction in some key workplace stressors, but no significant changes to their mental health or help-seeking for mental health problems. Further research is warranted, particularly to determine if these workplace changes will lead to improved mental health outcomes for doctors once maintained for a longer period.

An Initial Investigation of Suicide Attempt Disclosures Among US Veterans.

Background: Patient disclosure of prior suicidal behaviors is critical for effectively managing suicide risk; however, many attempts go undisclosed. Aims: The current study explored how responses following a suicide attempt disclosure may relate to help-seeking outcomes. Method: Participants included 37 veterans with a previous suicide attempt receiving inpatient psychiatric treatment. Veterans reported on their most and least helpful experiences disclosing their suicide attempt to others. Results: Veterans disclosed their suicide attempt to approximately eight individuals. Mental health professionals were the most cited recipient of their most helpful disclosure; romantic partners were the most common recipient of their least helpful disclosures. Positive reactions within the context of the least helpful disclosure experience were positively associated with a sense of connection with the disclosure recipient. Positive reactions within the most helpful disclosure experience were positively associated with the likelihood of future disclosure. No reactions were associated with having sought professional care or likelihood of seeking professional care. Limitations: The results are considered preliminary due to the small sample size. Conclusion: Findings suggest that while positive reactions may influence suicide attempt disclosure experiences broadly, additional research is needed to clarify factors that drive the decision to disclose a suicide attempt to a professional.

Seeking help despite the stigma: Experiential avoidance as a moderated mediator.

The help-seeking literature identifies a model wherein public stigma of seeking help is internalized as self-stigma of seeking help, which, in turn, decreases help-seeking outcomes. The current study considered whether experiential avoidance, or a tendency to avoid painful thoughts or emotions, moderates how strongly these stigmata relate to help-seeking intentions among university students. Specifically, this study tested whether experiential avoidance moderates (a) the direct relationship between self-stigma of seeking psychological help and help-seeking intentions and (b) the indirect relationship between public stigma and help-seeking intentions. Conditional process modeling in a university student sample (N = 235) supported these hypotheses. The direct relationship between self-stigma and help-seeking intentions was nonsignificant and weaker for those who reported low experiential avoidance than for those who reported high experiential avoidance. Results also demonstrated a moderated indirect effect wherein the relationship between self-stigma and intentions was nonsignificant among those reporting low levels of experiential avoidance. This suggests that self-stigma may predict help-seeking intentions when avoidance of therapy functions as a means for avoiding unpleasant emotions. These findings suggest that interventions designed to decrease experiential avoidance by increasing openness to unpleasant emotions may offer a novel avenue to attenuate the impact of self-stigma on help-seeking intentions without requiring the difficult task of reducing stigma altogether. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Men in unhappy relationships: Perceptions of couple therapy

Research suggests men are reluctant to seek couple therapy. Parnell and Hammer (2018) established the utility of the theory of planned behavior (TPB) in explaining men’s relationship help seeking. The present study addressed gaps in their investigation by using a sample of men ( N = 206) who reported being unhappy with their romantic relationship; incorporating the key theoretical constructs of relationship satisfaction, self-stigma of seeking help, and perceived need; parsing the unique relationship of conformity to the masculine norms of self-reliance and restrictive emotionality with help-seeking perceptions; and determining whether personality (i.e., neuroticism) obviated the importance of accounting for conformity to masculine norms when seeking to understand couple help seeking. To address these important research gaps, an structural equation modeling (SEM) alternative model testing framework was used and bootstrap analyses were conducted to test for indirect effects. The results evidenced several important findings: (1) conformity to masculine norms accounted for unique variance in help-seeking perceptions beyond neuroticism, (2) self-reliance and restrictive emotionality evidenced differential direct and indirect effects on help-seeking outcomes, (3) perceived need and self-stigma accounted for the most variance in the SEM model, and (4) relationship satisfaction was not associated with attitudes but low relationship satisfaction was associated with more perceived social pressure (i.e., subjective norms) to engage in couple therapy. Our results provided further support for the use of TPB in understanding men’s relationship help seeking and highlighted several implications for how to engage men in couple therapy.

Increasing Help-Seeking Outcomes among People with Elevated Depressive Symptomatology with Public Service Announcements: An Examination of Functional Matching and Message Sidedness

The current experimental study assessed the utility, and potential harm, of depression public service announcements (D-PSAs) that were matched, moderately matched, or mismatched based on attitude function (i.e., social-adjustive or object-appraisal) and either one-sided or refutational two-sided. US adults (N = 567) with mild to severe depressive symptomatology were randomly assigned to view control messages or one set of D-PSAs. Results indicate that functionally matched D-PSAs, regardless of message sidedness, caused more favorable help-seeking outcome expectations, attitudes, and intentions compared to the control messages. Exposure to the mismatched D-PSAs, particularly refutational, led to less-favorable help-seeking outcome expectations, attitudes, and intentions compared with the control condition. Help-seeking outcomes among those exposed to the moderately matched messages were not significantly different from those exposed to the control messages, with the exception of those exposed to the one-sided moderately matched messages. The one-sided moderately matched messages resulted in lower help-seeking intentions than the control messages. Overall, results indicate that if messages can be tailored to match the recipients’ attitude functions, help-seeking outcomes among people with heightened depressive symptomatology can be increased. However, the results also indicate that some D-PSAs can have negative effects.

Trauma Risk Management (TRiM): Promoting Help Seeking for Mental Health Problems Among Combat-Exposed U.K. Military Personnel

Objectives: Trauma Risk Management (TRiM) is a peer-led, occupational mental health support process that aims to identify and assist U.K. military personnel with persistent mental ill health related to potentially traumatic events (PTEs). This study compared help seeking, mental disorder symptoms, and alcohol use between TRiM recipients and personnel experiencing similar combat events who did not receive TRiM; an unexposed group provided context. Methods: Records of TRiM activity during a U.K. military deployment in Afghanistan were linked to contemporaneous survey data assessing mental health and combat experiences. The resulting deployment data set was amalgamated with mental health, alcohol use, and help-seeking data collected within 12 weeks of homecoming and again one to two years later. Mental health and help-seeking outcomes were compared between a nonexposed, non-TRiM sample (n = 161), an exposed, non-TRiM sample (n = 149), and an exposed, TRiM-recipient sample (n = 328) using logistic regression analyses. Results: At follow-up, TRiM recipients were significantly more likely to seek help from mental health services than exposed, non-TRiM personnel. At baseline, TRiM recipients had significantly greater adjusted odds of reporting possible posttraumatic stress disorder (PTSD) symptoms than exposed non-TRiM personnel; the difference was not significant at follow-up. TRiM recipients were significantly more likely to report persistent mental disorder and alcohol misuse caseness over the follow-up period. Conclusions: TRiM recipients were significantly more likely to seek help from mental health services than a similar PTE-exposed group that did not receive TRiM; however, TRiM recipients experienced more persistent mental ill-health symptoms and hazardous alcohol use over the period of follow-up despite seeking help.

Myocardial infarction, patient decision delay and help-seeking behaviour: a thematic analysis.

To explore patient decision delay, the symptom experience and factors that motivated the patient experiencing myocardial infarction to go to the emergency department. Reperfusion for myocardial infarction is more effective if performed as soon as possible after the onset of symptoms. Multiple studies show that prehospital delay is long and can average several hours. A qualitative descriptive design using semi-structured interviews. All consecutive myocardial infarction patients who between July 2013-January 2014 at a single-centre metropolitan tertiary hospital in Western Australia were included. Patient responses to an open-ended question were recorded and transcribed verbatim. Data were analysed using Braun & Clarke (Qual Res Psychol, 3, 2006, 77-101) thematic analysis method. Of the 367 eligible, 255 provided consent. Three themes emerged from the qualitative analyses: (1) onset and response to symptoms, and this included three subthemes: context of the event, diversity of symptom interpretation and response to symptoms; (2) help-seeking behaviour, and this included the patient seeking help from various lay and professional sources; and (3) help-seeking outcomes, which include calling the emergency ambulance, going to emergency department, seeing a general practitioner, seeing a general practitioner who advised them to go home. The context of the event, their symptomatology and the layperson who was the first point of contact influenced the decision for the patient to go to the emergency department. Many patients used private transport or contacted their general practitioner. New knowledge from this study emphasises the importance of the layperson understanding the appropriate response is to seek prompt care through immediate emergency transport by ambulance to emergency department. This study highlights the need to educate both the patient and the wider public, not only to seek prompt care but to also to call the emergency ambulance to arrange transport to the emergency department.

State Psychological Reactance to Depression Public Service Announcements Among People With Varying Levels of Depressive Symptomatology

Campaigns seeking to help people with depression can be effective, but they can also backfire. Psychological reactance is proposed as a partial explanation. Two experimental studies examined the effect of two depression messages (i.e., autonomy-supportive language, controlling language) for participants (n = 2027, n = 777) with varying levels of depressive symptomatology. For Study 1, two versions of a print public service announcement about seeking help for depression served as the experimental stimulus. Study 2 used an existing video public service announcement about seeking help for depression, but the text was altered to create the two conditions. In both studies, increased depressive symptomatology was associated with reduced help-seeking attitudes and intentions, as well as greater state reactance to a public service announcement about depression. Increased state reactance mediated the relationship between increased depressive symptomology and unfavorable help-seeking outcomes. Further, across the two studies, participants with high levels of depressive symptomatology who were exposed to the autonomy-supportive language ad reported either as much, or more, state reactance than participants with high levels of depressive symptomatology who were in the control condition. These results warn that language perceived as autonomy-supportive by people without depression might be perceived as controlling among people with depression.

Predictors of help-seeking for suicidal ideation in the community: Risks and opportunities for public suicide prevention campaigns

Predictors of help-seeking for suicidal ideation in the community: Risks and opportunities for public suicide prevention campaigns

The Impact of Universal Suicide-Prevention Programs on the Help-Seeking Attitudes and Behaviors of Youths

While the ultimate goal of adolescent suicide-prevention efforts is to decrease the incidence of death by suicide, a critical intermediary goal is directing youths toward effective sources of assistance. To comprehensively review the universal prevention literature and examine the effects of universal prevention programs on student's attitudes and behaviors related to help-seeking. We systematically reviewed studies that assessed help-seeking outcomes including prevention efforts utilizing (1) psychoeducational curricula, (2) gatekeeper training, and (3) public service messaging directed at youths. Of the studies reviewed, 17 studies evaluated the help-seeking outcomes. These studies were identified through a range of sources (e.g., searching online databases, examining references of published articles on suicide prevention). The results of this review suggest that suicide-prevention programming has a limited impact on help-seeking behavior. Although there was some evidence that suicide-prevention programs had a positive impact on students' help-seeking attitudes and behaviors, there was also evidence of no effects or iatrogenic effects. Sex and risk status were moderators of program effects on students help-seeking. Caution is warranted when considering which suicidal prevention interventions best optimize the intended goals. The impact on adolescents' help-seeking behavior is a key concern for educators and mental-health professionals.