Accessibility and availability of mental health care services are necessary but not sufficient for people to seek help for psychological problems. Attitudes and stigma related to help seeking also determine help seeking intentions. The aim of this study is to investigate how cross-national differences in attitudes and stigma within the general population are related to professional and informal help seeking intentions in low and high suicide rate regions.
By means of a postal structured questionnaire, data of 2999 Dutch and Flemish respondents between 18 and 65 years were gathered. Attitudes toward help seeking, perceived stigma, self-stigma, shame and intention to seek help were assessed.
People in the Netherlands, where suicide rates are low, have more positive attitudes toward help seeking and experience less self stigma and shame compared to the people in Flanders, where suicide rates are relatively high. These attitudinal factors predicted professional as well as informal help seeking intentions. Perceived stigma was negatively associated with informal help seeking. Shame was positively associated with higher intention to use psychotropic drugs and perceived stigma was negatively associated with the intention to seek help from a psychotherapist in Flanders but not in the Netherlands.
Help seeking for psychological problems prevent these problems to aggravate and it is assumed to be a protective factor for suicide. Our results stress the importance of the promotion of positive attitudes and the reduction of stigma within the general population to facilitate help seeking from professional providers and informal networks. Focusing on these attitudinal factors is believed to be a key aspect of universal mental health and suicide prevention policies.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Alonso J, Angermeyer MC, Bernert S, Bruffaerts R (2004) Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 109(Supl 420):47–54
Kessler RC, Demyttenaere K, Bruffaerts R, Posada-Villa J (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291:2581–2590
Deisenhammer EA, Huber M, Kemmler G, Weiss EM, Hinterhuber H (2007) Suicide victims’ contact with physicians during the year before death. Eur Arch Psychiatry Clin Neurosci 257:480–485
Sareen J, Jagdeo A, Cox BJ, Clara I, ten Have M, Belik SL, de Graaf R (2007) Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands. Psychatr Serv 58:357–364
Ajzen I, Fishbein M (2005) The influence of attitudes on behavior. In: Albarracin D, Johnson BT, Zanna MP (eds) The handbook of attitudes. Laurence Erlbaum, New Jersey, pp 173–221
Bathje GJ, Pryor JB (2011) The relationship of public and self-stigma to seeking mental health services. J Mental Health Couns 33:161–176
Komiti A, Judd F, Jackson H (2006) The influence of stigma and attitudes on seeking help from a GP for mental health problems. Soc Psychiatry Psychiatr Epidemiol 41:738–745
Vogel DL, Wade NG, Hackler AH (2007) Perceived public stigma and the willingness to seek counseling: the mediating roles of self-stigma and attitudes toward counseling. J Couns Psychol 54:40–50
ten Have M, de Graaf R, Ormel J, Vilagut G (2012) Are attitudes towards mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders. Soc Psychiatry Psychiatr Epidemiol 45:153–163
Rüsch N, Angermeyer MC, Corrigan P (2005) Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry 20:523–539
Ben-Portath DD (2002) Stigmatization of individuals who receive psychotherapy: an interaction between help-seeking behaviour and the presence of depression. J Soc Clin Psychol 21:400–413
Link BG, Cullen FT, Struening E, Shrout PE, Dohrenwend BP (1989) A modified labeling theory approach to mental disorders: an empirical assessment. Am Sociol Rev 54:400–423
Gulliver A, Griffiths KM, Christensen H (2010) Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10:113
Golberstein E, Eisenberg D, Gollust SE (2009) Perceived stigma and help-seeking behavior: longitudinal evidence from the Healthy Minds Study. Psychiatr Serv 60:1254–1256
Schomerus G, Matschinger H, Angermeyer MC (2009) The stigma of psychiatric treatment and help-seeking intentions for depression. Eur Arch Psychiatry Clin Neurosci 259:298–306
Griffiths KM, Crisp AH, Barney LJ, Reid R (2011) Seeking help for depression from family and friends: a qualitative analysis of perceived advantages and disadvantages. BMC Psychiatry 11:196
Holmes EP, River LP (1998) Individual strategies for coping with stigma of severe mental illness. Cogn Behav Pract 5:231–239
Barney LJ, Griffiths KM, Jorm AF, Christensen H (2006) Stigma about depression and its impact on help-seeking intentions. Aust N Z J Psychiatry 40:51–54
Pompili M, Mancinelli I, Tatarelli R (2003) Stigma as a cause of suicide. Br J Psychiatry 183:173–174
Kageyama T (2012) Views on suicide among middle-aged and elderly populations in Japan: their associations with demographic variables and feeling shame in seeking help. Psychiatry Clin Neurosci 66:105–112
Mojtabai R (2010) Mental illness stigma and willingness to seek mental health care in the European Union. Soc Psychiatry Psychiatr Epidemiol 45:705–712
Evans-Lacko, S., Brohan, E, Mojtabai, R, Thornicroft, G. (2012) Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine, 1–13. 2012. 16–11–2011
Angermeyer MC, Matschinger H, Riedel-Heller SG (1999) Whom to ask for help in case of a mental disorder? Preferences of the lay public. Soc Psychiatry Psychiatr Epidemiol 34:202–210
WHO World Mental Health Survey Consortium (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Survey. JAMA 21:2581–2590
Dezetter A, Briffault X, Bruffaerts R, De Graaf R, Alonso J, König HH, Haro JM, de Girolamo G, Vilagut G, Kovess-Masféty V (2012) Use of general practitioners versus mental health professionals in six European countries: the decisive role of the organization of mental health-care systems. Soc Psychiatry Psychiatr Epidemiol. doi:10.1007/s00127-012-0522-9
World Health Organization. (2011) Mental Health Atlas-2011 country profiles. http://www.who.int/mental_health/evidence/atlas/profiles/en/index.html. Accessed 20 may 2013
Beldie A, den Boer JA, Brain C et al (2012) Fighting stigma of mental illness in midsize European countries. Soc Psychiatry Psychiatr Epidemiol 47(Suppl 1):1–38
Flemish Agency for Care and Health. http://www.zorg-en-gezondheid.be/Cijfers/Sterftecijfers/Statistiek-van-de-doodsoorzaken/. Accessed 15 January 2013
World Health Organization-European Detailed Mortality Database. http://data.euro.who.int/dmdb/. Accessed 15 January 2013
Alonso J, Buron A, Rojas-Farreas S, de Graaf R, Haro JM, De Girolamo G, Bruffaerts R, Kovess V, Matschinger H, Vilagaut G (2009) Perceived stigma among individuals with common mental disorders. J Affect Disord 118:180–186
Aromaa E, Tolvanen A, Tuulari J, Wahlbeck K (2011) Personal stigma and use of mental health services among people with depression in a general population in Finland. BMC Psychiatry 11:52
Frankfort-Nachmias C, Nachmias D (1996) Research methods in the social science. Arnold, London
Ware JE, Kosinski M, Keller (1994) SF. SF-36 Physical and Mental Health Summary Scales: A User’s Manual. MA: The Health Institute, Boston
Schreurs PJG, van de Willige G (1988) Omgaan met problemen en gebeurtenissen: de Utrechtse coping lijst (UCL). Swets & Zeitlinger, Lisse
Vogel DL, Wade NG, Haake S (2006) Measuring the self-stigma associated with seeking psychological help. J Couns Psychol 53:325–337
Link BG (1987) Understanding labeling effects in the area of mental-disorders-an assessment of the effects of expectations of rejection. Am Sociol Rev 52:96–112
Link BG, Struening E, Neese-Todd S, Asmussen S, Phelan JC (2001) The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Serv 52:1621–1626
Fisher EH, Farina A (1995) Attitudes toward seeking professional psychological help: a shortened form and considerations for research. J Coll Stud Dev 36:368–373
Elhai JD, Schweinle W, Anderson SM (2008) Reliability and validity of the attitudes toward seeking professional psychological help scale-short formS Psychiatry Res 159:320–329
Baruch Y (1999) Response rate in academic studies- a comparative analysis. Human relations 52:421–438
Ravens-Sieberer U, Erhart M, Wetzel R, Krügel A, Brambosch A (2008) Phone respondents reported less mental health problems whereas mail interviewee gave higher physical health ratings. J Clin Epidemiol 61:1056–1060
Alonso J, Angermeyer MC, Bernert S, Bruffaerts R (2004) Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 109(Suppl 420):55–64
Hegerl U, Wittenburg L, Arensman E, Van Audenhove C, Coyne JC, McDaid D, van der Feltz-Cornelis C, Gusmão R, Kopp M, Maxwell M, Meise U, Roskar S, Sarchiapone M, Schmidtke A, Värnick A, Bramesfeld A (2009) Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach. BMC Public Health 9:428
This study was funded by the Flemish Government, Department of Well-being, Health and Family, LUCAS KU Leuven, the Centre for the Prevention of Suicide (Centrum ter Preventie van Zelfdoding) and Foundation Go for Happiness-Prevention of Depression and suicide (Stichting Ga voor Geluk-Preventie van Depressie en Suicide).
About this article
Cite this article
Reynders, A., Kerkhof, A.J.F.M., Molenberghs, G. et al. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Soc Psychiatry Psychiatr Epidemiol 49, 231–239 (2014). https://doi.org/10.1007/s00127-013-0745-4
- Cross-national research