Previous Mental Health Care Research Articles

Stigma and Demographic Correlates of Help‐Seeking Intentions in Returning Service Members

Many U.S. Iraq/Afghanistan-era veterans return from deployment with posttraumatic stress (PTS) symptoms, but few veterans seek psychological help. Research on barriers to care is growing, but the link between stigma and help-seeking is understudied. The present study examined anticipated enacted stigma from military and nonmilitary sources, self-stigma, PTS, perceived likelihood of deploying again, marital status, and history of mental health care engagement as correlates of help-seeking intentions from a mental health professional or medical doctor/advance practice registered nurse (MD/APRN) in a sample of 165 combat veterans. Using structural equation modeling, results demonstrated that self-stigma was negatively associated with help-seeking intentions from a mental health professional and MD/APRN with small-to-medium effect sizes. Being married was positively associated with help-seeking intentions from a mental health professional and MD/APRN with small effect sizes. History of previous mental health care engagement was positively associated with help-seeking intentions from a mental health professional with a medium effect size, but unrelated to help-seeking intentions from a MD/APRN. Anticipated enacted stigma from any source, PTS, and greater perceived likelihood of deploying again were unrelated to help-seeking intentions from a mental health professional and MD/APRN. Implications for interventions aimed at decreasing self-stigma and increasing intention to seek help are discussed.

Early Dropout in Men Voluntarily Undergoing Treatment for Intimate Partner Violence in Norway

This study investigated psychotherapy dropout rates and predictors of dropping out of therapy early. We enrolled 1,166 men voluntarily admitted to psychotherapy for violent behavior against a female partner. In total, 315 (23.8%) subjects dropped out of therapy within the first 3 sessions. Dropouts were significantly younger, more likely to have a non-Norwegian ethnic background, less likely to have received previous mental health care, and were more likely to have been treated by a student therapist. Among those treated by a student therapist, unemployment was strongly associated with early dropout. Unadjusted and adjusted results were similar. Clients and therapists may benefit by matching unemployed men with experienced therapists. Finally, the high dropout rates among ethnically non-Norwegian clients points to a need for special treatment approaches for this subgroup.

Risk Factors for Self-Harm in Children and Adolescents Admitted to a Mental Health Inpatient Unit

The aim of this study was to identify risk factors for self-harm for children and adolescents in a mental health inpatient unit. A retrospective file audit of patient files over three years (2006-2009) was conducted to determine risk factors associated with self-harm in children and adolescents admitted to a mental health unit. A checklist of potential factors was based on risk factors found in a review of the literature including demographic information, diagnosis, home situation, environmental stressors, childhood trauma and previous mental health care. The study compared those who self-harmed with a control group who did not self-harm. There were 150 patients who self-harmed (mean age 14 years) and 56 patients who did not self-harm with a mean age of 13 years. Several factors were identified that increased the likelihood of self-harm, including a diagnosis of depression, female gender, increasing age, being Australian-born, living with a step parent, not having received previous mental health care, having a history of trauma, and having other stressors including problems within the family. While increasing age, female gender, a history of trauma and a diagnosis of depression are well known as risk factors for self-harm, this study confirms that family factors, in particular living with a step parent, significantly add to the risk. Child and adolescent services should be aware of the increased risk of self-harm in young people with mental health problems who live in blended families. Treatment approaches need to involve parents as well as the child or young person.

Can hopelessness and adolescents' beliefs and attitudes about seeking help account for help negation?

Avoidance of appropriate help is common in acutely suicidal samples and has been confirmed in nonclinical samples but factors that contribute to this help negation effect remain unclear. In a sample of 269 nonclinical Australian high school students, the current study examines the impact of hopelessness, previous mental health care, beliefs, and attitudes toward professional psychological help on the help negation relationship. Results revealed that suicidal ideation significantly predicted lower help seeking intentions and that although hopelessness could not explain the help negation effect, it moderated the effect for seeking help from family. They also revealed that although previous mental health care was unable to explain the effect fully for professional mental health sources, beliefs and attitudes about professional psychological help could. Implications of the findings for prevention, primary health care, and professional psychological practice are discussed.

The development of word meaning: From monolingual to bilingual acquisition

People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.

Adolescent suicide attempters: Do physicians recognize them?

The single most important risk factor for adolescent suicide is a previous attempt. It is unclear if physicians can identify adolescents who have attempted suicide. Our objectives were to determine the prevalence of previous attempts in an adolescent clinic population, if physicians identify attempters, and if attempters demonstrate persistent distress. Of 332 patients aged 12–19 years attending a medical clinic, 48 (14.5%) reported a previous attempt. The physician's visit note documented that only 8 (16.7%) of the 48 attempters were asked about suicidal behavior. Attempters were more likely than nonattempters ( p < 0.05) to be female; to come to clinic without a guardian; to give a chief complaint pertaining to sexually transmitted disease, obstetrics-gynecology, or mental health; and to report previous mental health care. Attempters had poorer mean scores ( p < 0.05) on validated subscales for family relationships, social competence, depression, unpopularity, somatic complaints, thought disorders, delinquency, aggression, and identity. We conclude that suicide attempts are common among adolescent clinic patients, that physicians may not recognize attempters, and that attempters remain distressed and in need of care. Physicians who see adolescents for routine medical problems must consider the potential for self-destructive behavior, regardless of the presenting complaint.

Risk Factors for Attempted Suicide During Adolescence

It is unknown whether adolescents can provide the information necessary to identify their risk for attempted suicide. The present study was designed to determine whether data collected directly from adolescents can be used to develop a simple model for differentiating suicidal from nonsuicidal adolescents. Patients aged 13 to 19 years hospitalized for medical complications of serious suicide attempts (n = 56) or for acute illnesses unrelated to injuries or ingestions (n = 248) completed self-administered questionnaires pertaining to psychosocial function, recent stress, alcohol and drug use, and health care use. Compared with ill adolescents, suicidal adolescents had poorer mental health, impulse control, family relationships, and school performance; higher 3-month stress scores and alcohol-use scores; and more use of 7 of 12 drugs (P less than .05). Compared with ill adolescents, suicidal adolescents were more likely to report previous suicide attempts (39% vs 10%, P less than .001) and previous mental health care (27% vs 8%, P less than .001) but were less likely to identify a primary care site (61% vs 87%, P less than .001). In a logistic regression model based on previous suicide attempts, previous mental health care, poor school performance, marijuana use, and dependence on the emergency room for primary care, 84% of the suicidal and 55% of the ill adolescents were correctly identified. If validated prospectively, these five self-administered questions may constitute a helpful screen for the rapid identification of suicidal adolescents.

Family physician referrals for psychiatric consultation and patient initiative in seeking care

This report examines in a prepaid medical group practice, the role of doctor and patient initiative in the family physician's referral decision. Patients referred to the psychiatrist are classified according to whether the referral was patient-initiated or doctor-initiated; those not referred were classified according to whether or not they had ever wished a referral. Comparisons are presented among these groups based on patient interview information on demographic characteristics, reports on their emotional problems, previous mental health care and doctor-patient relations. Comparisons are also made among some patient groups on information from family physician interviews.