Mental health and health care
DEPRESSION IS THE most common psychiatric disorder, affecting more than one in four Americans (Satcher, 1999). Of the 30,000 Americans who commit suicide every year, 90% have some mental disorder, often depression (Hyman, 2000). Although depression can be effectively treated, potential consumers conceal their symptoms and are reluctant to seek treatment. The present study explores the issue of how negative attitudes toward depression influence care seeking choices for depression.
The mental health community has long grappled with stigma as a barrier to care and recently the issue has gained momentum. The Surgeon General’s Report on Mental Health cited the public’s stigmatization of all mental illness as a leading cause of underdiagnosis and undertreatment (Satcher, 1999). The President’s New Freedom Commission on Mental Health (2003) recommended that decisive action be taken to reduce the stigma of care seeking, pronouncing that no matter how good our nation’s mental health services are, they are pointless if people will not use them.
Seeking care for depression is complicated by the disorder itself. Depression creates global negativity and dangerously deflates self-esteem. Because of stigma, admitting that the problem could be depression may cause further damage to feelings of self worth-“Only weak people get depressed. If I am depressed, I am weak.” Even when people accept that depression may be the problem, care seeking is complicated by the mystery of the mental health care system. Potential consumers are unaware of what kind of help they need, don’t know where help is available, and are uncertain that there would be any benefit to seeking care. Learning from the experience of others is impeded by fear of stigmatization-people often conceal that they were treated for depression. This concealment also serves to increase the sense of failure and isolation of the depressed individual-“No one else is such a loser.”
Two large national studies shed light on the public’s attitude toward depression. In the United Kingdom, 25% of respondents endorsed statements indicating that individuals with severe depression were dangerous, and 20% claimed that these individuals could “pull themselves together” (Crisp, 2001). Americans interviewed for the General Social Survey (National Opinion Research Center, 1996) identified those with depression as “likely to do something violent to others” at a rate of 33%, and nearly 37% believed that a person with major depression would get better without help. This perception of a lack of need for treatment is supported by the notion that depression was more often attributed to stress (54%) than chemical causation (21%). More than a third of the respondents reported that they were definitely or probably unwilling to interact with an individual with depression.
Negative perceptions regarding depression can be better understood by Weiner’s (2000) attribution model. According to this model, stigmas are the result of negative perceptions regarding whole categories people. We categorize others to enhance a sense of order, to provide explanations for others’ behavior, and to emphasize the difference between the afflicted and ourselves. Two perceptions most often linked to discrimination against mental illness are controllability and dangerousness (Corrigan et al., 2001). The more control persons with mental illness are thought to have over their condition, the more likely others will assign blame and ascribe responsibility. Dangerousness results in fear and avoidance.
It stands to reason that people who hold stigmatizing views of depression would also hold negative attitudes toward seeking care for depression. The purpose of this study was to increase our understanding of how attitudes toward mental health care is influenced by negative perceptions, especially from consumers representing a cross-section of the general population. This study examines the influence of stigma on care-seeking for depression with the expectation that there would be an inverse relationship between stigmatizing attitudes and intention to seek help for depressive symptoms.
Methods
Sample
Subjects for this study were adults recruited from waiting rooms of two healthcare facilities. One was a suburban primary care office and the other was an urban adult health clinic. Participants were patients and companions of patients waiting to be seen. The goal was to obtain a sample of both men and women that was diverse in age and race. A total of 134 individuals were asked to participate in the study. About 91% (122) agreed and completed the questionnaires. Accounting for missing data and incomplete questionnaires there were 117 useable surveys.
Measures
Study participants completed a Demographic Data Form. This form consisted of demographic items and person-level variables including gender, age, marital status, race, political affiliation, orientation to political issues, socioeconomic status, and religious affiliation
The second inventory used was the Attribution Questionnaire developed by Corrigan et al. (2001). The questionnaire presented a vignette describing a person suffering from depressive symptoms as drawn from criteria listed in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, Fourth Edition (American Psychiatric Association, 2000). Subjects were asked questions which measured their emotional reactions and behavioral responses to the person with depression using a seven-point Likert-type scale. There were 27 questions which represent nine factors, measured by three items each. Six of these factors are derived from attribution theory and address responsibility, affective mediation (anger or pity), and behavioral reactions (help, coercion, and punishment). Three additional factors represent specific issues related to mental illness and stigma-the attribution of dangerousness, the affective response of fear, and the behavioral reaction of avoidance.
Tags: mental health