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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.
Sociologists often interpret racial differences in help-seeking behavior in the United States as stemming from differences in cultural capital, an implication being that those who hesitate to seek help lack understanding of how important it is for success. In this paper, we draw on the work of W. E. B Du Bois and research on gender and racial stereotypes to show that it is not a lack of understanding about the importance of help-seeking, but rather, Black women’s double consciousness that underlies their reluctance to seek help relative to White women. Through twenty-nine in-depth interviews with Black and White college-aged women, we investigate how they make meaning of two competing ideals: the need to be seen as a strong woman and the need for help and social support. We identify a discourse around gender stereotypes for White participants and intersectional stereotypes for Black participants. Where Black and White women experience a consciousness born out of their marginalization relative to men, comparing how they differently navigate stereotypes about strong women reveals the analytic power of Du Bois’s concept of double consciousness. First, the “veil” reveals the racialized gender stereotypes Black women worry they might confirm by seeking help. Second, Black women’s sense of “twoness” means they more often than White women saw their help-seeking behaviors as reflecting negatively on their broader community. Finally, consistent with Du Bois’s point that “second sight” brings awareness but not liberation, we find that even though Black women were hyperaware of the disadvantages of not seeking help, they tended more often than White women to reach a breaking point before seeking it.
Prospective university students experience substantial academic stressors and psychological vulnerabilities, yet their mental health literacy (MHL) remains inadequately explored. This study investigates four dimensions of MHL – help-seeking behaviors, stigma, knowledge about mental health and understanding of mental illnesses. Besides, Geographic Information System (GIS) techniques are employed to analyze spatial disparities in MHL, which is the first in the context of MHL research. A total of 1,485 students were assessed for sociodemographic characteristics, admission-related variables, health behaviors and family histories of mental health issues. Data were analyzed using SPSS and ArcGIS software. Multivariable linear regression analyses unveiled predictors of the MHL dimensions, with gender, family income, admission test performance, smoking, alcohol and drug use, physical and mental health history, current depression or anxiety and family history of mental health and suicide incidents emerging as common predictors. GIS analysis unraveled notable regional disparities in MHL, particularly in knowledge of mental health and mental illness, with northern and some southern districts displaying higher literacy levels. In conclusion, these findings accentuate significant gender and sociodemographic inequalities in MHL among prospective university students, highlighting the imperative for targeted interventions to enhance MHL and foster mental well-being in this cohort.
Self-harm is a significant problem in university students because of its association with emotional distress, physical harm, broader mental health issues and potential suicidality. Research suggests that fewer than half of students who have self-harmed seek professional help when at university.
Aims
This study aimed to explore the help-seeking journeys of university students who had engaged in self-harm, to identify perceived facilitators and barriers to securing both formal and informal support.
Method
Participants comprised 12 students who had self-harmed during their university tenure. Engaging in two semi-structured interviews over the academic year, they shared insights into their help-seeking behaviours and proposed enhancements to local services. Data underwent reflexive thematic analysis within a critical realist framework.
Results
The analysis identified four themes: ‘The initial university phase poses the greatest challenge’, ‘Perceived criteria for “valid” mental health problems’, ‘Evading external judgements, concerns and consequences’ and ‘The pivotal role of treatment options and flexibility in recovery’.
Conclusions
Students felt isolated and misunderstood, which amplified self-harming tendencies and diminished inclinations for help-seeking. A prevalent belief was that for self-harm to be deemed ‘valid’, it must manifest with a certain severity; however, concurrent fears existed around the ramifications of perceived excessive severity. Participants expressed a desire for streamlined pathways to mental health resources, encompassing both university and external mental health services. Insights from this study could guide future research and inform current service paradigms within academic and healthcare systems.
Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students.
Methods
We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children’s Anxiety and Depression Scale (RCADS).
Results
Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR) = 1.36; 95% confidence interval (CI): 1.29–1.43) and perceived unmet need for mental health services (OR = 1.47; 95% CI: 1.37–1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR) = 1.25; 95% CI: 1.17–1.34 with a significant interaction between RCADS and ACE scores, aOR = 0.88; 95% CI: 0.84–0.93) as well as perceived unmet need (aOR = 1.32; 95% CI: 1.21–1.43 with a significant interaction between RCADS and ACE scores, aOR = 0.85; 95% CI: 0.78–0.91).
Conclusions
Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.
People with hoarding behaviours often struggle to engage in treatment. This study aimed to explore the experiences of a sample of people who identify as engaging in hoarding behaviours and who are seeking support. Exploring motivation to seek help, the barriers those who hoard face in accessing support and what facilitates accepting help, can aid understanding of how best to intervene.
Method:
Eight individuals who self-identified as seeking help in relation to hoarding behaviours were recruited via social media and support groups. Interviews were conducted by telephone or video call, before being transcribed and analysed using interpretative phenomenological analysis.
Results:
Participants described complex help-seeking narratives and reported continued ambivalence about addressing their hoarding behaviours. The four group experiential themes identified were Wrestling with identity; Who can I trust?; Services don’t fit; and Being overlooked: ‘they’re too busy looking at the thing, not the person’. Difficulties trusting others and services were identified; services were experienced as rejecting and many participants sought help for problems other than their hoarding. Problems accessing appropriate help for hoarding were predominant in the narratives, although participants who had accessed peer support described this as valuable.
Conclusions:
There are both internal (e.g. fear of judgement; feeling overwhelmed) and external (e.g. service gaps) barriers that make finding useful help for hoarding behaviours very difficult. Services may facilitate those seeking help by taking a compassionate and person-centred approach to hoarding problems.
Perinatal depression is the most undertreated clinical condition during the perinatal period. Knowledge about women's decision-making in seeking and receiving treatment is scarce.
Aims
To investigate and compare treatment option uptake in perinatal women with depressive symptoms in Portugal and Norway, and to identify sociodemographic and health-related factors associated with treatment uptake.
Method
Participants were women resident in Portugal or Norway (≥18 years) who were pregnant or had given birth in the past 12 months, who presented with active depressive symptoms (Edinburgh Postnatal Depression Scale score ≥10). In an electronic questionnaire, women reported treatment received and sociodemographic and health-related factors.
Results
The sample included 416 women from Portugal and 169 from Norway, of which 79.8% and 53.9%, respectively, were not receiving any treatment. Most Portuguese women were receiving psychological treatment, either alone (45.2%) or combined with pharmacological treatment (21.4%). Most Norwegian participants were receiving only pharmacological (36.5%) or combined treatment (35.4%). Compared with the Portuguese sample, a higher proportion of Norwegian women started treatment before pregnancy (P < 0.001). In Portugal, lower depressive symptoms and self-reported psychopathology were significantly associated with higher likelihood of receiving treatment.
Conclusions
We found that, in both Norway and Portugal, a substantial number of perinatal women with depressive symptoms do not receive any treatment. Differences exist regarding the chosen treatment option and timing of treatment initiation in the two countries. Only mental health-related factors were associated with treatment uptake for perinatal depression in Portugal. Our results highlight the importance of implementing strategies aimed to improve help-seeking behaviours.
We undertook a rapid review of literature relating to the diagnosis of blood cancers, to find out what factors contribute to delays in diagnosis, including symptom recognition, appraisal and help-seeking behaviours.
Methods:
We used rapid review methodology following Tricco et al. to synthesise current literature from two electronic databases. We searched for studies about symptom appraisal help-seeking for all blood cancers published between 2001 and 2021, written in English.
Results:
Fifteen studies were included in the review, of which 10 were published in the United Kingdom. We found a number of factors associated with delays in blood cancer diagnosis. These included patient factors such as gender, age and ethnicity, as well as health system factors such as poor communication and seeing a locum clinician in primary care. A narrative synthesis of the evidence produced four types of symptom interpretation by patients: (1) symptoms compatible with normal state of health, (2) event-linked problems, (3) mild or chronic illness and (4) non-specific unwell state. These four interpretations were linked to different help-seeking behaviours. After seeking help, patients often experienced delays due to healthcare professionals’ (HCPs’) non-serious interpretation of symptoms, misleading blood tests, discontinuity of care and other barriers in the diagnostic pathway.
Conclusion:
Blood cancers are difficult to diagnose due to non-specific heterogeneous symptoms, and this is reflected in how those symptoms are interpreted by patients and managed by HCPs. It is important to understand how different interpretations affect delays in help-seeking, and what HCPs can do to support timely follow-up for patients.
We will first examine whether seeking help for depression and schizophrenia from mental health professionals is nowadays more accepted among the German public than it used to be 30 years ago. Next, we will explore whether changes in help-seeking preferences between 1990 and 2020 are specific to mental health professions or are part of changes in attitudes to professional help-seeking in general. Finally, we will study whether a temporal relationship does exist between the advent of awareness-raising and anti-stigma campaigns after the turn of the millennium and changes in the acceptance of mental health care.
Methods
In 1990 (n = 2044), 2001 (n = 4005), 2011 (n = 1984) and 2020 (n = 2449) methodologically identical population-based surveys were conducted in Germany. After presentation of an unlabelled case vignette depicting someone with either schizophrenia or depression, we asked about help-seeking recommendations for the person described.
Results
The German public's readiness to recommend seeking help from mental health professionals has markedly grown over the past 30 years. In contrast, in the eyes of the public, turning to a general practitioner has become only slightly more, consulting a priest even less advisable than it used to be three decades ago. Seeing a naturopath is seen with markedly less disapproval today compared to 1990, but explicit recommendation of this helping source has not increased correspondingly in. The most pronounced increase in the German public's propensity to recommend seeking help from mental health professionals occurred already in the 1990s, i.e. before efforts to heighten public awareness had started.
Conclusions
Today, the German public is more in favour of mental health professionals than it used to be three decades ago. This seems to be a specific trend, and not to reflecting an increasing propensity towards professional help-seeking in general. Our findings counter the narrative that mental health communication efforts and initiatives have created more favourable attitudes towards mental health care among the public, since the observed changes in attitudes have preceded any campaigns. Instead, we tend to interpret the rise of the popularity of mental health professionals as a reflection of general cultural changes that have taken place over the past decades in Germany, as in other western countries.
Social anxiety disorder (SAD) is a common mental health condition that is characterised by a persistent fear of social or performance situations. Despite effective treatments being available, many individuals with SAD do not seek treatment or delay treatment seeking for many years. The aim of the present study was to examine treatment barriers, treatment histories, and cognitive behavioural therapy (CBT) delivery preferences in a sample of women with clinically relevant SAD symptoms. Ninety-nine women (Mage = 34.90, SD = 11.28) completed the online questionnaires and were included in the study. Participants were recruited from advertisements on community noticeboards and posts on social media. The results demonstrated that less than 5% of those who received psychological treatment in the past were likely to have received best-practice CBT. The most commonly cited barriers to accessing treatment for women with SAD related to direct costs (63%) and indirect costs (e.g., transport/childcare) (28%). The most preferred treatment delivery method overall was individual face-to-face treatment (70%). The study demonstrates a need to provide a variety of treatment options in order to enhance access to empirically supported treatment for women with SAD.
Studies that explain men’s reduced willingness for formal help-seeking for depressive symptoms often did not analyze whether assumed unique barriers, namely, conformity to masculine norms (CMN), reduced self-compassion, and self-stigma are also linked to women’s help-seeking behavior.
Objectives
The current study analyzed whether CMN, self-compassion, and self-stigma for help-seeking are linked to women’s and men’s willingness to seek formal help for depressive symptoms.
Methods
German-speaking participants (N=481; 68.8% women, 31.2% men; Mage=35.6, SD=14.2) of an online-questionnaire study read a vignette about a character with depressive symptoms. Participants indicated how likely they would be to seek medical or psychological help if they were in the character’s situation. Furthermore, the Conformity to Masculine Norms Inventory, Self-Stigma of Seeking Help scale, and Self-Compassion Scale were used.
Results
Women and men were moderately willing to seek formal help for depressive symptoms. A manifest path model revealed that strong CMN and low self-compassion were linked to strong self-stigma in women and men. Strong self-stigma was associated with reduced help-seeking intentions. In men with low self-compassion CMN was directly linked to reduced willingness for help-seeking. In women and men with strong self-compassion no direct, but indirect links between CMN and reduced help-seeking intentions via self-stigma were found.
Conclusions
CMN and self-stigma of help-seeking were not unique barriers in men, but also were relevant for women’s formal help-seeking intentions. Even though increased self-compassion was associated with decreased self-stigma, interventions that aim to increase self-compassion may not help increase help-seeking behaviors.
People in the asylum system who might benefit from mental health care frequently find it very difficult to access this.
Some do not seek help, perhaps because they do not expect mental health services to be helpful or because of fear, stigma, or wanting to avoid the processes of help-seeking.Those who do seek help encounter multiple challenges including language barriers, the limitations of health care provision within the asylum system, difficulties negotiating primary care, NHS charges, practical difficulties in getting to a first appointment, and service eligibility criteria. People may face barriers linked to their age, gender, sexuality, or being destitute.
The chapter offers a typology of obstacles to reaching effective mental health care as a step towards considering how these may be addressed.This considers the context (resource limitations /ambivalence about providing equal care) and the sources of specific obstacles, including ‘hostile’ asylum policies. Recurring themes include the need for accessible information,friendly compassionate staff, cultural competence, access to qualified interpreters, appropriately trained staff, and a willingness to be flexible.
Suicide-related Internet use is becoming more common, and many research study its potential risks and benefits.
Objectives
Data on suicidal thoughts and Internet use of patients with depressive disorders were collected to assess their suicide-related Internet use and its relation to help-seeking preferences.
Methods
Semi-structured interviews were completed to assess Internet use patterns and suicidal thoughts among patients treated with depressive disorders, and preferred forms of help-seeking were also examined.
Results
113 patients completed the interviews, most of them spend more hours a day using the Internet. More than 80% came across suicide-related contents while browsing, a quarter reported specific search for suicidal contents. In case of suicidal thoughts, three-quarters of depressed patients would seek help from a mental health professional, two-thirds from their partners, half from friends, and nearly one-third from parents, other relatives or from GPs. Most patients would prefer offline (personal) help for their psychological problems and suicidal thoughts, online methods were less preferred, with only one-fifth choosing these options. However, a third of them also considered it probable that they would not ask anyone for help.
Conclusions
Despite of the frequent use of the Internet, online help-seeking is less common in depressive patients. However, in the times of pandemic, online help facilities may provide an opportunity to prevent suicidal behavior for those, who have suicidal thoughts and use the Internet regularly, especially searching for suicide-related contents. In the future, further research is needed to develop more effective online suicide prevention programs and applications.
An expansive body of research has investigated the adverse consequences of self-stigma of seeking psychological help on help-seeking tendencies. Therefore, this chapter provides a meta-analysis of the extant literature regarding the empirical relationship between self-stigma and help-seeking attitudes and intentions. An exhaustive review of the research literature was performed on all articles published in English that assessed a statistical relationship between self-stigma and at least one other help-seeking variable such as help-seeking attitudes, intentions, willingness, or future help-seeking behaviors. We extracted data from 145 articles and included them in the meta-analyses, of which, 120 were utilized to examine the relationship between self-stigma and help-seeking attitudes, 74 were utilized to examine the relationship between self-stigma and help-seeking intentions, 3 were utilized to examine the relationship between self-stigma and future help-seeking behaviors, and 4 were utilized to examine the relationship between self-stigma and decisions to seek online help-seeking information. The meta-analyses uncovered a strong negative relationship between help-seeking self-stigma and help-seeking attitudes, moderate negative relationships between self-stigma and help-seeking intentions as well as between self-stigma and actual future help-seeking behaviors, and a small effect size for the negative relationship between self-stigma and decisions to seek online help-seeking information.
Stigma and discrimination in relation to dementia has a range of implications for people living with dementia and their families worldwide, including help-seeking, quality of life, social rejection and isolation. Few studies consider the perceptions and stigma towards dementia from multiple perspectives, such as people living with dementia, carers, general public and health-care workers. South Africa has limited evidence on the stigmatisation of people living with dementia, with responses to people living with dementia being driven by poor understanding of the condition, cultural beliefs about causes and social interaction problems associated with memory and cognitive impairment. This study explored the experiences of stigma among people living with dementia and their carers through understanding their own knowledge, attitudes and beliefs as well as those of the public and health-care workers. Qualitative data (N = 52) were collected across two provinces and in four languages (English, Afrikaans, Sesotho and isiZulu), with semi-structured interviews and focus groups with the following stakeholder groups: people living with dementia and their carers, the general public and health-care workers. Inductive thematic analysis generated themes across stakeholder groups. The study shows that people living with dementia and carers experienced high levels of internalised stigma, related to negative public attitudes, which were associated with high levels of isolation, health system unpreparedness and limited access to support. The study contributes to the evidence base needed in South Africa but also extends its relevance by contributing to a growing global evidence base on stigma and dementia in low- and middle-income contexts.
The spectrum of adverse mental health trajectories caused by sexual abuse, broadly defined as exposure to rape and unwanted physical sexual contact, is well-known. Few studies have systematically appraised the epidemiology and impact of sexual abuse among boys and men. New meta-analytic insights (k = 44; n = 45 172) reported by Zarchev and colleagues challenge assumptions that men experiencing mental ill health rarely report sexual abuse exposure. Adult-onset sexual abuse rates of 1–7% are observed in the general population, but for men experiencing mental ill health, adult lifetime prevalence was 14.1% (95% CI 7.3–22.4%), with past-year exposure 5.3% (95% CI 1.6–12.8%). We note that these rates are certainly underestimates, as childhood sexual abuse exposures were excluded. Boys and men with a sexual abuse history experience substantial disclosure and treatment barriers. We draw attention to population health gains that could be achieved via implementation of gender-sensitive assessment and intervention approaches for this at-risk population.
Alcohol use disorder (AUD) has been described as a chronic relapsing condition, yet most individuals who develop AUD will reduce or resolve their problem, and many will “recover.” This chapter summarizes historical and contemporary definitions of recovery, including those developed by key stakeholder groups and definitions based on research with individuals who meet AUD criteria and resolve their problems with or without treatment. The literature supports an expanded definition of recovery as an ongoing dynamic behavior change process characterized by relatively stable improvements in biopsychosocial functioning and purpose in life. Definitions focused solely on abstinence and absence of AUD symptoms do not capture the multidimensional and heterogeneous pathways to recovery found in general population and clinical samples, and non-abstinent recovery is possible. The chapter discusses a shift away from a pathology-based model of recovery towards a strength-based, resilience-building model that recognizes many possible pathways to stable positive change.
Although treatment samples dominate research on recovery from alcohol use disorder (AUD), natural recovery is the dominant recovery pathway in the population with problems. This chapter summarizes key natural recovery research findings: (1) Most individuals with AUD never receive treatment; associations among AUD severity, help-seeking, and recovery are complex; and influences on help-seeking and behavior change are not wholly redundant. (2) Drinking practices and improved functioning are not highly correlated, indicating domains for defining recovery require expansion. (3) Moderation outcomes are more common in natural than treatment-assisted recovery attempts, in part because most treatments emphasize abstinence. (4) Compared to abstinence and relapse, moderation outcomes of natural recovery attempts are associated with distinct variability in drinking practices and monetary spending patterns that increase access to valued non-drinking rewards. This variability in AUD problem severity, help-seeking, and recovery patterns merits consideration in defining recovery and guiding services across the AUD spectrum.
How individuals try to solve problems, from simple to life-threatening ones, has been a central question across the scientific landscape. Not surprisingly, disciplines have offered theories representing their unique perspectives from cost, psychological predispositions, social status, culture, power, and even genetic inheritance. What was common across these explanations, even as larger structures or context were considered to limit or enhance action, was the focus on individuals, the primary assumption of action as decision-making or help-seeking, and an internal cost-benefit mechanism. While providing many insights, this understanding of the basis of human action falls short. The social network perspective suggests a shift to the influence of others on social action and a reconsideration of underlying assumptions. This reflection considers how applying an approach where social networks are the engine of action produced the Social Organization Strategy framework, the Network Episode Model, subsequent revisions, and the multi-level, multi-disciplinary Network Embedded Symbiome. This chapter describes how this social network perspective guides a new research effort on human well-being — the Person-to-Person Health Interview Study — and includes specific measurement batteries for ego-centric data collection.
An important reason personal networks matter is that individuals can turn to them when they have a need. But how do people decide whom in their network to turn to? Researchers across several literatures have studied this question under different rubrics, including “help-seeking behavior,” “the mobilization of social capital,” and the “activation of social ties.” The question arises when people seek social support, information about jobs, help when they are ill, advice about college enrollment, and more. The process of turning to others is ultimately a decision, and the research addressing this question has explicitly proposed or implicitly suggested the common-sense notion that, when deciding, people first assess their needs and options and then choose the best available match between the former and the latter. This idea suggests that the decision-making process is largely consistent across situations, autonomous in nature, and at least minimally deliberative. In what follows, I argue instead that, in practice, the process is heterogeneous across situations; that the heterogeneity can be characterized by the degree to which it is internal vs external, deliberative vs intuitive, and personal vs organizational; and that it can be expressed in terms of an interaction space and an institutional space of possibilities. I outline the conditions likely to shape the decision-making process in each space, and propose that the more intuitive mobilization is, the more it will depend on interaction conditions, and the more organizational it is, the more it will depend on institutional ones. I discuss the substantive, theoretical, and methodological implications of understanding decision-making in context, and propose an agenda for future work.