Racial Differences in Attitudes Toward Professional Mental Health Treatment: The Mediating Effect of Stigma
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.Journal of Gerontological Social Work 10/2009; 52(7):695-712. DOI: 10.1080/01634370902914372
Stigma associated with mental illness continues to be a pervasive barrier to mental health treatment, leading to negative attitudes about treatment and deterring appropriate care seeking. Empirical research suggests that the stigma of mental illness may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with a mental illness, particularly African Americans. However, little research has examined the impact of stigma on racial differences in attitudes toward seeking mental health treatment. This study examined the hypothesis that stigma partially mediates the relationship between race and attitudes towards mental health treatment in a community-based sample of 101 African American and White older adults. Multiple regression analyses and classic path analysis was utilized to test the partial mediation model. Controlling for socio-demographic factors, African American older adults were more likely to have negative attitudes toward mental health treatment, and they also reported more public and internalized stigma than their White counterparts. As hypothesized, the relationship between race and attitudes toward mental health treatment was partially mediated by internalized stigma, suggesting that internalized stigma may cause older adults to develop negative attitudes about mental health treatment. The partial mediation model was not significant for public stigma, however. Implications for social work research and practice are discussed.
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- "Race/Ethnicity and Attitudes toward Psychotherapy In addition to the potential moderating role race/ethnicity plays in the relationship between stigma and help-seeking attitudes, race/ethnicity by itself also may predict attitudes toward psychotherapy. Several studies have found that racial/ethnic groups do differ in their attitudes (Conner et al., 2009; Gonzalez et al., 2005). For example, in one meta-analysis with data from 5,713 "
ABSTRACT: This study sought to examine the role of current/previous treatment experience, stigma (social and self), and cultural identification (Caucasian and Alaska Native [AN]) in predicting attitudes toward psychological help seeking for ANs. Results indicated that these variables together explained roughly 56% of variance in attitudes. In particular, while self-stigma and identification with the Caucasian culture predicted a unique amount of variance in helpseeking attitudes, treatment use and identification with AN culture did not. The results of this study indicate that efforts to address the experience of self-stigma may prove most useful to improving help-seeking attitudes in ANs.
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- "While the latter feature may have contributed to our understanding of the evolution of stigma coping strategies over-time, it may also have underestimated the experience of self-stigma, i.e. internalizing the devaluing attitudes of the 'general public'. Since research has suggested that mental stigma is experienced differently in different cultures (Nadeem et al., 2007; O'Conner et al., 2009) and by various related family members (Corrigan et al., 2011), future studies should include a more heterogeneous population of family members. "
ABSTRACT: Background: Studies have indicated that family members of persons with mental illness often experience stigma in relation to their relatives’ illness. Less is known about the type of experiences they face and how they cope with these experiences. Aims: To explore family members’ experiences and efforts to cope with mental illness stigma in social encounters. Method: A qualitative immersion/crystallization analysis of focus group data was used to examine family members’ experiences and responses to perceived stigma. Results: Family members reported experiencing rejection, blame and avoidance by others, engendering hurt, disappointment and shame. They employed flexible coping strategies depending on their personal resources, motivation, and their relatives’ willingness to disclose. Conclusion: Findings suggest that families learn from their own experience the “art of selective disclosure”: what, when, how much and who to share information with. Coping strategies are developed based on the situation and family members’ needs and personal resources which differ between families and over time.
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- "People living with chronic illnesses who have internalized stigma may be less likely to access care because they feel that they do not deserve care or that care may not work for them. Although there has been no direct research on internalized stigma with chronic illness, research on people living with mental illness who have internalized stigma shows that they have poorer attitudes toward mental health treatment (Conner et al., 2009). Similarly, people who perceive that they have experienced stigma in healthcare settings may be less likely to access care because they do not want to face additional negative treatment. "
ABSTRACT: Approximately half of adults are living with a chronic illness, many of whom may feel stigmatized by their chronic illness in different contexts. We explored the impact of internalized, experienced, and anticipated stigma within healthcare settings on the quality of life of 184 participants living with chronic illnesses (e.g. diabetes, inflammatory bowel disease, asthma). Results of a path analysis demonstrate that participants who internalized stigma and experienced stigma from healthcare workers anticipated greater stigma from healthcare workers. Participants who anticipated greater stigma from healthcare workers, in turn, accessed healthcare less and experienced a decreased quality of life.
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