Stigma and the Acceptability of Depression Treatments Among African Americans and Whites

Boston University, Boston, Massachusetts, United States
Journal of General Internal Medicine (Impact Factor: 3.42). 09/2007; 22(9):1292-7. DOI: 10.1007/s11606-007-0276-3
Source: PubMed


Stigma is associated with depression treatment, however, whether stigma differs between depression treatment modalities is not known, nor have racial differences in depression treatment stigma been fully explored.
To measure stigma for four depression treatments and estimate its association with treatment acceptability for African Americans and whites.
Cross-sectional, anonymous mailed survey.
Four hundred and ninety African-American and white primary care patients.
The acceptability of four depression treatments (prescription medication, mental health counseling, herbal remedy, and spiritual counseling) was assessed using a vignette. Treatment-specific stigma was evaluated by asking whether participants would: (1) feel ashamed; (2) feel comfortable telling friends and family; (3) feel okay if people in their community knew; and (4) not want people at work to know about each depression treatment. Sociodemographics, depression history, and current depressive symptoms were measured.
Treatment-specific stigma was lower for herbal remedy than prescription medication or mental health counseling (p < .01). Whites had higher stigma than African Americans for all treatment modalities. In adjusted analyses, stigma relating to self [AOR 0.43 (0.20-0.95)] and friends and family [AOR 0.42 (0.21-0.88)] was associated with lower acceptability of mental health counseling. Stigma did not account for the lower acceptability of prescription medication among African Americans.
Treatment associated stigma significantly affects the acceptability of mental health counseling but not prescription medication. Efforts to improve depression treatment utilization might benefit from addressing concerns about stigma of mental health counseling.

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    • "Such potential factors may include patient beliefs and social norms regarding AD treatment [30-32]; health care providers’ attitudes towards immigrant patients [12]; and the cross-cultural communication skills of health care providers [11]. Moreover, ethnic differences in the acceptability of AD treatment [27-29], differences in the beliefs about the causes of and potential cures for illness [51,52], or differences in the social stigma associated with depression and AD treatment [53] may influence patient medication-taking behavior [30-32]. Furthermore, stressors related to migration [54,55] may be hypothesized to influence immigrant patients’ mental resources to cope with disease and adhere to treatment. "
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    ABSTRACT: Antidepressant (AD) therapy is recommended for patients 4-12 months after remission from depression. The aim was to examine whether immigrants (refugees or family reunited immigrants) from non-Western countries are at greater risk than Danish-born residents of 1) not initiating AD therapy after discharge and 2) early AD discontinuation. A cohort of immigrants from non-Western countries (n = 132) and matched Danish-born residents (n = 396) discharged after first admission with moderate to severe depression between 1 January 1996 and 31 May 2008 was followed in the Danish registries.Logistic regression models were applied to explore AD initiation within 30 days after discharge, estimating odds ratio (OR) for immigrants versus Danish-born residents.Early discontinuation was explored by logistic regression, estimating OR for no AD dispensing within 180 days after the first dispensing, and by Cox regression, estimating hazard ratio (HR) for discontinuation (maximum drug supply gap) within 180 days. Immigrants had higher odds for not initiating AD treatment after discharge than Danish-born residents (OR = 1.55; 95% CI: 1.01-2.38). When income was included in the model, the strength of the association was attenuated. Odds for early discontinuation was non-significantly higher among immigrants than Danish-born residents (OR = 1.80; 0.87-3.73). Immigrants also had a non-significantly higher hazard of early discontinuation (HR = 1.46; 95% CI: 0.87-2.45). Including income had only minor impact on these associations. Immigrants seem less likely to receive the recommended AD treatment after hospitalization with depression. This may indicate a need for a better understanding of the circumstances of this vulnerable group.
    Full-text · Article · Mar 2014 · BMC Psychiatry
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    • "Stigma causes the person with mental illness to face problems such as finding housing, employment,[4] access to judicial systems, and using health services, which cause isolation,[4] sense of shame,[5] and decrease psychosocial functions such as low self-esteem,[1] dissatisfaction with life, and mental health problems.[6] Moreover, stigma has a negative impact on the recovery process, treatment, seeking treatment, acceptance of psychological counseling,[7] and adherence to drug treatment.[8] "
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    ABSTRACT: Stigma is one of the obstacles in the treatment and regaining the mental health of people with mental illness. The aim was determination of mental illness stigma among nurses in psychiatric wards. This study was conducted in psychiatric wards of teaching hospitals in Tabriz, Urmia, and Ardabil in the north-west of Iran. This research is a descriptive analysis study in which 80 nurses participated. A researcher-made questionnaire was used, which measured demographic characteristics and mental illness stigma in the three components of cognitive, emotional, and behavioral. All data were analyzed using SPSS13 software and descriptive and analytical statistics. Majority of nurses (72.5%) had medium level of stigma toward people with mental illness. About half of them (48.8%) had great inclination toward the social isolation of patients. The majority of them (62.5%) had positive emotional responses and 27.5% had stereotypical views. There was a significant correlation between experience of living with and kinship of nurses to person with mental illness, with prejudice toward and discrimination of patients. There was also a significant correlation between interest in the continuation of work in the psychiatric ward and prejudice, and also between educational degree and stereotypical views. The data suggest there is a close correlation between the personal experience of nurses and existence of mental illness stigma among them. Therefore, the implementation of constant educational programs on mental illness for nurses and opportunities for them to have direct contact with treated patients is suggested.
    Full-text · Article · Nov 2012 · Iranian journal of nursing and midwifery research
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    • "‘Treatment stigma’ refers to the stigma and discrimination that individuals believe to be associated with receiving care for a mental health problem. We identified nine treatment stigma scales or subscales [27,39-46] from our on-going systematic review. The measures were in the main Likert attitude scales (measures with statements followed by ‘strongly agree’, ‘agree’ etc.). "
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    ABSTRACT: Many people with mental illness do not seek or delay seeking care. This study aimed to develop, and provide an initial validation of, a comprehensive measure for assessing barriers to access to mental health care including a 'treatment stigma' subscale, and to present preliminary evidence about the prevalence of barriers experienced by adults currently or recently using secondary mental health services in the UK. The Barriers to Access to Care Evaluation scale (BACE) was developed from items in existing scales, systematic item reduction, and feedback from an expert group. It was completed in an online survey by 117 individuals aged 18 and over who had received care from secondary mental health services in the past 12 months. Internal consistency, test-retest reliability, convergent validity (correlation of treatment stigma subscale with the Stigma Scale for Receiving Psychological Help (SSRPH) and with the Internalised Stigma of Mental Illness Scale (ISMI)), respondent opinion and readability were assessed. The BACE items were found to have acceptable test-retest reliability as all but one of the items exceeded the criterion for moderate agreement. The treatment stigma subscale had acceptable test-retest-reliability and good internal consistency. As hypothesised the subscale was significantly positively correlated with the SSRPH and the ISMI demonstrating convergent validity. The developmental process ensured content validity. Respondents gave the BACE a median rating of 8 on the 10-point quality scale. Readability scores indicated the measure can be understood by the average 11 to 12 year-old. The most highly endorsed barrier was 'concern that it might harm my chances when applying for jobs'. The scale was finalised into a 30-item measure with a 12-item treatment stigma subscale. There is preliminary evidence demonstrating the reliability, validity and acceptability of the BACE. It can be used to ascertain key barriers to access to mental health care which may help to identify potential interventions to increase care seeking and service use. Further research is needed to establish its factor analytic structure and population norms.
    Full-text · Article · Apr 2012 · BMC Psychiatry
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