How can service use for mental illness be improved? A quasi-experimental online study on the potential for change of personal stigma and intermediary variables in the context of service use
Public Health, Healthcare Research, Social and Occupational Medicine
Final Report Abstract
In this completed research project, variables influencing the utilisation of professional health-care among individuals with depressive symptoms were investigated. The focus was on mediating psychological variables and interventions based on them, with the aim of enhancing professional help-seeking and reducing stigmatising attitudes that are “barriers” to help-seeking. The main results of the project including the summary presentation and testing of the Seeking Mental Health Care Model were published in scientific journals. The model reveals the following key findings: self-identification as having a mental illness emerged as an explanatory and modifiable variable influenced by continuum beliefs about mental illness and health, mental health literacy, and a biopsychosocial conception of causal beliefs. To operationalise causal beliefs, a novel approach considering the breadth of the concept was developed. The study introduced the concept of selfefficacy in relation to help-seeking and self-help. Like in previous research, the influences were observed on help-seeking intention but not behaviour. Two systematic reviews on continuum beliefs provided valuable insights, informing the development and evaluation of a new scale. Participatory intervention principles were incorporated into the intervention design but should be explored in standardised research. Stigma reduction due to interventions targeting intrapsychic variables was observed consistently across the study. Similar results in control and experimental groups suggest the impact of combined intervention content. Stigma reduction effects were evident after reading a depression literacy intervention, and after a video-based continuum beliefs intervention. Unexpectedly, the causal beliefs intervention seemed to inhibit stigma reduction instead of supporting it. No significant effects were found regarding actual help-seeking behaviour. Further investigation is needed to explore potential benefits of interventions on other types of help-seeking, e.g., from friends or family, and how they interact with professional help-seeking. The study explored the influences of treatment experiences and depression severity, which provide a basis for developing more targeted intervention content. Effective studies should combine balanced intervention content with individual tailoring, exploring effective combinations of content and presentation formats. Based on the results, a combination of continuum beliefs and mental health literacy could be considered, while a biopsychosocial causal concept should be used cautiously. Promising approaches, such as videos, the integration of social components, and gamification elements, were explored in a preliminary manner. External factors should be further incorporated to evaluate the practical effectiveness of content for specific target groups. Public health campaigns delivering multimedia messages could help reduce stigma and provide support for individuals with mental illnesses.
Publications
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Continuum beliefs and mental illness stigma: a systematic review and meta-analysis of correlation and intervention studies. Psychological Medicine, 51(5), 716-726.
Peter, Lina-Jolien; Schindler, Stephanie; Sander, Christian; Schmidt, Silke; Muehlan, Holger; McLaren, Thomas; Tomczyk, Samuel; Speerforck, Sven & Schomerus, Georg
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How can the utilisation of help for mental disorders be improved? A quasi-experimental online study on the changeability of stigmatising attitudes and intermediate variables in the process of utilisation. BMC Public Health, 21(1).
McLaren, Thomas; Peter, Lina-Jolien; Tomczyk, Samuel; Muehlan, Holger; Stolzenburg, Susanne; Schomerus, Georg & Schmidt, Silke
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Continuum beliefs of mental illness: a systematic review of measures. Social Psychiatry and Psychiatric Epidemiology, 58(1), 1-16.
Tomczyk, S.; Schlick, S.; Gansler, T.; McLaren, T.; Muehlan, H.; Peter, L.-J.; Schomerus, G. & Schmidt, S.
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Determinanten der Inanspruchnahme psychischer Gesundheitsversorgung – ein integratives Modell. Public Health Forum, 31(3), 223-226.
Peter, Lina-Jolien; McLaren, Thomas; Tomczyk, Samuel; Muehlan, Holger; Schmidt, Silke & Schomerus, Georg
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The Seeking Mental Health Care model: prediction of help-seeking for depressive symptoms by stigma and mental illness representations. BMC Public Health, 23(1).
McLaren, Thomas; Peter, Lina-Jolien; Tomczyk, Samuel; Muehlan, Holger; Schomerus, Georg & Schmidt, Silke
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Yes, I can! Development and validation of the self-efficacy for self-help scale. Journal of Affective Disorders, 331, 279-286.
Tomczyk, Samuel; Heineck, Sascha; McLaren, Thomas; Peter, Lina-Jolien; Schomerus, Georg; Schmidt, Silke & Muehlan, Holger
