What Attributes of Integrated Health Care for Mental Health Are the Most Important to Potential Consumers? A Relative Ranking Study.

Integrated health care (IHC) is efficacious, cost-effective, and more attractive to some consumers than traditional standalone psychotherapy, but the specific characteristics of IHC that drive this enhanced attraction have yet to be explored among potential future mental health consumers. As such, this brief report documents the results of a survey of 428 US adults who were asked to rank order the relative personal importance of seven characteristics (e.g., self-stigma mitigation, prompt appointment, saving money). These seven characteristics have been characterized in the IHC literature as potential beneficial elements of seeking mental health care from a provider in certain integrated health care settings. Getting sufficient information about one's health and treatment from one's provider was rated as most important, whereas co-location of mental/medical care and treatment privacy were rated as least important. The authors found evidence for select hypothesized demographic effects (e.g., interprovider communication rated more important for older adults) on how these factors were ranked. Professionals invested in developing and improving mental health care systems that are attractive and accessible to consumers in need of mental health care can consider the present findings when making decisions about which characteristics (e.g., getting sufficient information) should be maximized in the design and marketing of such systems. Future research, particularly longitudinal studies that assess prospective treatment seeking behavior, can build on the present study by examining the degree to which these attributes attract consumers to IHC settings.

Reputable and affordable programs with a strong commitment to diversity: Factors influencing school psychology student admission decisions.

A current issue in the field of school psychology is the extreme shortage of school psychologists, and this is likely to persist in the future. Effective recruitment into school psychology programs is one of the most important strategies to increase the number of school psychologists. Within the present study, researchers created the Graduate Enrollment Admissions Rating Scale (GEARS), a survey measuring several different factors that school psychology students consider when applying to graduate programs, to determine what factors contributed to school psychology students' choice of program. The GEARS was sent via email to current school psychology graduate students. Overall, current students rated program quality, including faculty friendliness, as the most important factor influencing their decision. Second, considerations reflecting the program cost were influential. Diversity issues were the third most important factor in students choosing their school psychology programs. Costs and research/teaching opportunities were more important in the recruitment of doctoral students than specialist students, but specialist students valued convenience of a program more than doctoral students. Results of this study suggest that faculty members in charge of recruiting need to consider ways to manage tuition costs, develop relationships with future students, and strive toward high-quality programs as the best ways to increase the likelihood that students will attend their university. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of integrated care and co-location of care on mental help-seeking perceptions.

BACKGROUND: Integrated care may offer a solution to subpar mental health referral adherence, but people's openness to receiving psychological treatment in this setting is understudied. AIMS: The present study examined the influence of the integrated care context and co-location of care on people's help-seeking perceptions. METHOD: This study (N = 397) used an experimental vignette design to compare the impact of treatment type (integrated care vs. traditional psychotherapy) and distance (close vs. far) on help-seeking perceptions. RESULTS: The integrated care environment (significant effect on perceived behavioral control) and closer proximity of the psychologist (significant effect on intention, attitudes, perceived effectiveness of treatment, self-stigma) only improved help-seeking perceptions among those with prior experience with mental health treatment. In the overall sample, treatment type and distance only demonstrated an effect among women, but not men. CONCLUSIONS: Pending replication with samples from diverse populations, these findings provide a cautionary tale about lay perceptions of integrated care's anticipated utility. However, co-location and, to a lesser degree, the common attributes of the integrated care format (e.g. team approach, flexible scheduling) may represent a potential pathway for reducing resistance to help seeking that can accompany traditional psychotherapy referrals among those with past exposure to behavioral healthcare.

A model of intention to provide mental health first aid in college students.

BACKGROUND: Psychologically distressed college students' peers are often the first line of mental health support. Mental health first aid (MHFA) focuses on the quality of early intervention provided by peers to those in psychological distress but has neglected what motivates college students to provide MHFA. AIMS: The current study used the MHFA framework and bystander theory as a foundation to examine factors influencing college students' intention to provide MHFA. METHODS: Participants were 778 U.S. college students from a larger group of college students (N = 29,765) from the 2015-2016 Healthy Minds Study archival dataset. Secondary data analysis using path analysis modeling was used to test for both direct and indirect effects. RESULTS: The specified path analysis model demonstrated exact fit to the data, χ2(67) = 82.359, p = 0.098. Personal stigma decreased MHFA intention, whereas both perceived MHFA efficacy and personal responsibility increased MHFA intention. Of note, perceiving campus climate as supportive of helping others indirectly increased MHFA intention. CONCLUSIONS: The current study supports a theory-driven framework rooted in the MHFA and bystander theory literature that could facilitate targeted interventions aimed at improving mental health prevention via college student prosocial behavior.

Collegian help seeking: the role of self-compassion and self-coldness.

BACKGROUND: Researchers have identified a two-factor structure of self-compassion (i.e. self-compassion and self-coldness). To date, no research has examined each of these constructs' role in collegian professional help-seeking intention. AIM: The current study sought to assess the role of self-compassion and self-coldness in collegian professional help-seeking intention, accounting for other theoretically and empirically-supported help-seeking constructs. METHOD: Participants included 9349 collegians recruited as part of the national 2015-2016 Healthy Minds Study archival dataset. A logistic regression was conducted to examine the unique contributions of self-compassion and self-coldness in predicting professional help-seeking intention, controlling for key help-seeking variables. RESULTS: A test of the full model against a constant only model was statistically significant, which indicated that the predictors collectively distinguished between collegians who intended to seek help from a professional clinician compared to those who did not. The Wald criterion indicated that both self-compassion and self-coldness were uniquely associated with intention to seek professional help. Self-compassion increased and self-coldness decreased the probability of seeking professional help. CONCLUSIONS: The study highlights the importance of self-compassion and self-coldness in collegian help-seeking intention. These findings can inform specific outreach efforts targeting both self-compassion and self-coldness.

Using Item Response Theory to Develop Revised (SSOSH-7) and Ultra-Brief (SSOSH-3) Self-Stigma of Seeking Help Scales.

The current research developed ultra-brief (SSOSH-3) and revised (SSOSH-7) versions of the Self-Stigma of Seeking Help scale. Item response theory was used to examine the amount of information each item provided across the latent variable scale and test whether items functioned differently across women and men. In a sample of 857 community adults, results supported removal of three reverse-scored items to create the SSOSH-7. The three most informative items were retained to create the SSOSH-3. Differential item functioning testing supported the use of both versions across women and men. Results replicated in an undergraduate student sample (n = 661). In both samples, the SSOSH-3 (αs = .82-.87) and SSOSH-7 (αs = .87-.89) demonstrated evidence of internal consistency. The SSOSH-3 (rs ≥ .89) and SSOSH-7 (rs ≥ .97) were highly correlated with the original SSOSH across samples and demonstrated significant correlations with help-seeking constructs and in similar magnitude to the original SSOSH.

Development and evaluation of a new short form of the Conformity to Masculine Norms Inventory (CMNI-30).

The Conformity to Masculine Norms Inventory (CMNI) has been an important tool in researching masculinity. With the original measure at 94 items (Mahalik et al., 2003), there have been several abbreviated forms developed from 11 to 55 items. However, in confirmatory factor analyses (CFA's) testing 13 common factors, bifactor, hierarchical, and unidimensional models, only 4 models demonstrated adequate fit to the data, and most of these were for the still quite long 46-item version. As a result, there was no psychometrically strong truly short form of the CMNI. In the present study, data from 1561 community and university men were used to develop a short form. First an exploratory factor analysis using a portion of the data was conducted, which resulted in a 10-subscale dimensionality, followed by CFA estimating a common factors model. The results of the CFA were used to create two candidate models for a 30-item short form of the CMNI, based on Classical test theory (CTT) and optimized CTT. The best-fitting candidate model for the CMNI-30 was CTT. Next, the fit of the 29, 46, and 94 item models were compared to the 30-item version, which had the superior fit. Then, measurement invariance between White men and men of color was assessed, choosing this comparison because hegemonic masculinity is theorized to marginalize men of color. Evidence was found for full configural and metric, and partial scalar and residuals invariance. Finally, significant relationships between CMNI-30 scores and indicators of depression and anxiety provides preliminary concurrent evidence for its validity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Mental health literacy as theory: current challenges and future directions.

BACKGROUND: Mental health literacy (MHL) is one increasingly researched factor thought to influence mental health behaviors. Researchers have argued for expanding the definition of MHL to include additional constructs, but no consensus has yet been reached on what constructs should be included as part of MHL. AIMS: The purpose of this paper is to (i) elucidate how the expansion of the MHL construct has impeded the growth of MHL research and (ii) through the lens of construct and theory development, highlight how these challenges might be remedied. METHODS: An inclusive search of the literature was undertaken to identify MHL studies. The principles of construct and theory development guided a critical analysis of MHL. RESULTS: The review of the literature found that MHL violates many principles of what constitutes an acceptable construct definition. To address these concerns, we proposed conceptualizing MHL as a theory and recommended principles of theory development that should be taken into consideration. CONCLUSION: A theory of MHL can guide future researchers to clearly delineate important constructs and their interrelationships. For practitioners, a theory of MHL can help inform how to improve MHL at both the individual and community level.

Disentangling Gratitude: A Theoretical and Psychometric Examination of the Gratitude Resentment and Appreciation Test-Revised Short (GRAT-RS).

This study extended our theoretical and applied understanding of gratitude through a psychometric examination of the most popular multidimensional measure of gratitude, the Gratitude, Resentment, and Appreciation Test-Revised Short form (GRAT-RS). Namely, the dimensionality of the GRAT-RS, the model-based reliability of the GRAT-RS total score and 3 subscale scores, and the incremental evidence of validity for its latent factors were assessed. Dimensionality measures (e.g., explained common variance) and confirmatory factor analysis results with 426 community adults indicated that the GRAT-RS conformed to a multidimensional (bifactor) structure. Model-based reliability measures (e.g., omega hierarchical) provided support for the future use of the Lack of a Sense of Deprivation raw subscale score, but not for the raw GRAT-RS total score, Simple Appreciation subscale score, or Appreciation of Others subscale score. Structural equation modeling results indicated that only the general gratitude factor and the lack of a sense of deprivation specific factor accounted for significant variance in life satisfaction, positive affect, and distress. These findings support the 3 pillars of gratitude conceptualization of gratitude over competing conceptualizations, the position that the specific forms of gratitude are theoretically distinct, and the argument that appreciation is distinct from the superordinate construct of gratitude.

Physician referral to a psychologist: Testing alternative behavioral healthcare seeking models.

OBJECTIVE: Primary care physicians (PCPs) often refer patients to psychological services, but help-seeking factors in the context of behavioral healthcare referral are understudied. This study examined perceptions of seeking psychological help for depression by comparing alternative structural equation models derived from the Theory of Reasoned Action (TRA). METHOD: Internet survey participants (N = 685 US adults, 77% female, M age = 45) imagined themselves in a vignette scenario in which they are experiencing depression symptoms and encouraged by a PCP to see a psychologist. RESULTS: Results supported the indirect model, in which the links between distal help-seeking factors (i.e., self-stigma, symptom recognition, perceived effectiveness of treatment) and intention to follow through on the referral to the psychologist were fully mediated by the more proximal TRA factors (i.e., attitudes, subjective norms, etc). CONCLUSIONS: Our findings supported the use of TRA in understanding peoples' intention to seek psychological help for depression when referred by their PCP.

Dimensionality, reliability, and predictive evidence of validity for three help-seeking intention instruments: ISCI, GHSQ, and MHSIS.

People's intention to seek help from a mental health professional is thought to be the proximal cause of help-seeking behavior and thus is a dependent variable frequently measured by help-seeking researchers. Using a research design that accounted for actual future help-seeking behavior, the present study documented the dimensionality, internal consistency, and predictive evidence of validity of 3 intention instruments: the Intentions to Seek Counseling Inventory (ISCI), General Help Seeking Questionnaire (GHSQ), and Mental Help-Seeking Intention Scale (MHSIS). The sample was composed of 405 community-dwelling adults who self-identified as currently experiencing a mental health concern. Results provided support for the ISCI's 3-factor structure and the internal consistency of its 3 subscale scores. In contrast, the GHSQ did not demonstrate clear evidence of adequate measurement model fit or internal consistency in the present sample. Results also tentatively suggested that the 3-item MHSIS is a unidimensional instrument that produces an internally consistent total score with appropriate construct replicability. The ability of these instruments to predict who would seek help from a mental health professional in the next 3 months was also examined. The MHSIS demonstrated the strongest evidence of predictive validity (about 70% of participants were correctly classified), followed by the GHSQ and ISCI. (PsycINFO Database Record

Mental Help Seeking Attitudes Scale (MHSAS): Development, reliability, validity, and comparison with the ATSPPH-SF and IASMHS-PO.

Attitudes is a key help-seeking construct that influences treatment seeking behavior via intention to seek help, per the theory of planned behavior (TPB). This article presents the development and psychometric evaluation of the Mental Help Seeking Attitudes Scale (MHSAS), designed to measure respondents' overall evaluation (unfavorable vs. favorable) of their seeking help from a mental health professional. In Study 1 (N = 857 United States adults), exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response theory (IRT) analysis were used to identify an optimal set of 9 items that demonstrated initial evidence of internal consistency, unidimensionality, and strong measurement equivalence/invariance (ME/I) across gender, past help-seeking experience, and psychological distress. Initial convergent evidence of validity was demonstrated via theoretically anticipated relationships between the MHSAS and key variables in the help-seeking nomological network (e.g., subjective norms, perceived behavioral control, intention, public stigma, self-stigma, anticipated risks and benefits, gender, previous help seeking). Initial incremental evidence of validity was demonstrated when the MHSAS demonstrated the ability to account for unique variance in help-seeking intention, beyond that accounted for by the Attitudes Toward Seeking Professional Psychological Help-Short Form scale (ATSPPH-SF) and the Psychological Openness subscale of the Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS-PO). Study 2 (N = 207 United States adults at Times 1 and 2) provided initial evidence of test-retest reliability over a 3-week period. The MHSAS offers mental health professionals a new tool for measuring attitudes that may avoid limitations of current help seeking-attitudes measures (e.g., construct-irrelevant variance). (PsycINFO Database Record

Men's Mental Health Help-Seeking Behaviors: An Intersectional Analysis.

Men seek mental health treatment less often than women. The present study sought to elucidate identities and individual difference characteristics that are associated with enhanced or decreased mental health help-seeking in a large national sample of U.S. men. Using data from 4,825 U.S. men aged 20 to 59 years, main effects of race/ethnicity, sexual orientation, age, income-poverty ratio, relationship status, depression symptoms, and body mass index were explored within the sample of men as well as intersections of these predictors with racial/ethnic group identity. While the results of main effects testing generally supported prior research (i.e., greater mental health care help-seeking among White men, nonheterosexual men, men not in relationships, older men, and more depressed men), when examined associations across racial/ethnic groups, the direction and strength of these associations showed notable variation-variation unaccounted for in prior research. These findings highlight the need for future theory building and research that accounts for this variation at the intersection of race/ethnicity and these specific predictors of help-seeking behavior among men.

Further examination of the factor structure of the Male Role Norms Inventory-Short Form (MRNI-SF): Measurement considerations for women, men of color, and gay men.

Using multigroup structural equation modeling in a large sample of online-survey respondents (N = 6,744), the present study examined the reliability and dimensionality of the Male Role Norms Inventory-Short Form (MRNI-SF), a popular measurement of traditional masculinity ideology (TMI), and also tested measurement invariance between individuals that do and do not fit the White heterosexual male TMI reference group. Results indicated that (a) it is appropriate to model the MRNI-SF using either a bifactor or unidimensional model but not a second-order model, (b) the raw MRNI-SF total score is a suitable measure of the general TMI construct, (c) the raw self-reliance through mechanical skills and negativity toward sexual minorities subscale scores may be appropriate measures of their respective specific factors (akin to subscale factors), and (d) SEM or ipsatizing procedures should be used to model the 5 other specific factors, given the insufficient model-based reliability of their raw subscale scores. When comparing men to women, White men to Black and Asian men, and gay men to heterosexual men, the MRNI-SF demonstrated configural invariance and at least partial metric invariance (i.e., measured similar constructs). However, scalar and residuals invariance were only supported for Asian men compared to White men. Taken together, these findings suggest that a general TMI factor of the MRNI-SF is best represented by a bifactor model, even in individuals that do not fit the White heterosexual male TMI reference group, but the instrument may be tapping somewhat different constructs in women, Black men, and gay men. (PsycINFO Database Record

Highly Aggressive Women in a Forensic Psychiatric Hospital.

In this study, we compared three groups of women admitted to a public forensic inpatient facility over the course of a two-year period. Detailed and systematic examination of social and psychiatric histories revealed that the group with the most persistent levels of aggression differed from the other two groups with respect to frequency of self-harming behavior, intellectual impairment, hypothyroidism, a childhood diagnosis of attention deficit-hyperactivity disorder (ADHD), and age of onset of psychiatric and behavioral symptoms. The high-aggression group also had the highest rate of childhood physical and sexual abuse, but the difference between that group and the two lower aggression groups did not achieve statistical significance. From the standpoint of childhood adversity, 94 percent of those in the high-aggression group had been placed outside of the original home by age 11. Eighty-nine percent were intellectually impaired. At admission, physical examinations revealed that 50 percent had a history of hypothyroidism and two-thirds were obese. Before admission, most had manifested severe aggression and emotional dysregulation, as evinced by high levels of self-harm, suicide attempts, and aggressive behavior in previous institutional settings that was both frequent and intense. Patients who share these characteristics are currently placed on a ward at the hospital with a milieu and individual therapy programs that are based on a dialectical behavior therapy approach that targets key symptoms of emotional and behavioral dysregulation.

Disentangling self-stigma: are mental illness and help-seeking self-stigmas different?

Two established but disparate lines of research exist: studies examining the self-stigma associated with mental illness and studies examining the self-stigma associated with seeking psychological help. Whereas some researchers have implicitly treated these 2 constructs as synonymous, others have made the argument that they are theoretically and empirically distinct. To help clarify this debate, we examined in the present investigation the overlap and uniqueness of the self-stigmas associated with mental illness and with seeking psychological help. Data were collected from a sample of college undergraduates experiencing clinical levels of psychological distress (N = 217) and a second sample of community members with a self-reported history of mental illness (N = 324). Confirmatory factor analyses provide strong evidence for the factorial independence of the 2 types of self-stigma. Additionally, results of regression analyses in both samples suggest that the 2 self-stigmas uniquely predict variations in stigma-related constructs (i.e., shame, self-blame, and social inadequacy) and attitudes and intentions to seek help. Implications for researchers and clinicians interested in understanding stigma and enhancing mental health service utilization are discussed.

Cross-cultural validity of the Self-Stigma of Seeking Help (SSOSH) scale: examination across six nations.

Researchers have found that the stigma associated with seeking therapy--particularly self-stigma--can inhibit the use of psychological services. Yet, most of the research on self-stigma has been conducted in the United States. This is a considerable limitation, as the role of self-stigma in the help-seeking process may vary across cultural groups. However, to examine cross-cultural variations, researchers must first develop culturally valid scales. Therefore, this study examined scale validity and reliability of the widely used Self-Stigma of Seeking Help scale (SSOSH; Vogel, Wade, & Haake, 2006) across samples from 6 different countries (England, Greece, Israel, Taiwan, Turkey, and the United States). Specifically, we used a confirmatory factor analysis framework to conduct measurement invariance analysis and latent mean comparisons of the SSOSH across the 6 sampled countries. Overall, the results suggested that the SSOSH has a similar univariate structure across countries and is sufficiently invariant across countries to be used to explore cultural differences in the way that self-stigma relates to help-seeking behavior.

Is stigma internalized? The longitudinal impact of public stigma on self-stigma.

Stigma is considered an important barrier to seeking mental health services. Two types of stigma exist: public stigma and self-stigma. Theoretically, it has been argued that public stigma leads to the development of self-stigma. However, the empirical support for this assertion is limited to cross-sectional data. Therefore, the goal of this research was to examine the relationship between public stigma and self-stigma over time. Perceptions of public and self-stigma were measured at Time 1 (T1) and then again 3 months later at Time 2 (T2). Using structural equation modeling, we conducted a cross-lag analysis of public stigma and self-stigma among a sample of 448 college students. Consistent with assertions that public stigma leads to the development of self-stigma, we found that public stigma at T1 predicted self-stigma at T2, whereas the converse was not true. These findings suggest that if self-stigma develops from public stigma, interventions could be developed to interrupt this process at the individual level and reduce or eliminate self-stigma despite perceptions of public stigma.

Assessing the utility of the willingness/prototype model in predicting help-seeking decisions.

Prior research on professional psychological help-seeking behavior has operated on the assumption that the decision to seek help is based on intentional and reasoned processes. However, research on the dual-process prototype/willingness model (PWM; Gerrard, Gibbons, Houlihan, Stock, & Pomery, 2008) suggests health-related decisions may also involve social reaction processes that influence one's spontaneous willingness (rather than planned intention) to seek help, given conducive circumstances. The present study used structural equation modeling to evaluate the ability of these 2 information-processing pathways (i.e., the reasoned pathway and the social reaction pathway) to predict help-seeking decisions among 182 college students currently experiencing clinical levels of psychological distress. Results indicated that when both pathways were modeled simultaneously, only the social reaction pathway independently accounted for significant variance in help-seeking decisions. These findings argue for the utility of the PWM framework in the context of professional psychological help seeking and hold implications for future counseling psychology research, prevention, and practice.

"Boys don't cry": examination of the links between endorsement of masculine norms, self-stigma, and help-seeking attitudes for men from diverse backgrounds.

The role of conformity to dominant U.S. masculine norms as an antecedent to help-seeking attitudes in men has been established using convenience samples made up largely of college-age and European American males. However, the role of conformity to masculine norms on help-seeking attitudes for noncollege-age men or for men from diverse backgrounds is not well understood. To fill this gap in the literature, the present study examined the cross-cultural relevance of a mediational model of the relationships between conformity to dominant U.S. masculine norms and attitudes toward counseling through the mediator of self-stigma of seeking counseling for 4,773 men from both majority and nonmajority populations (race/ethnicity and sexual orientation). Structural equation modeling results showed that the model established using college males from majority groups (European American, heterosexual) may be applicable to a community sample of males from differing racial/ethnic groups and sexual orientations. However, some important differences in the presence and strengths of the relationships between conformity to dominant masculine norms and the other variables in the model were present across different racial/ethnic groups and sexual orientations. These findings suggest the need to pay specific theoretical and clinical attention to how conformity to dominant masculine norms and self-stigma are linked to unfavorable attitudes toward help seeking for these men, in order to encourage underserved men's help-seeking behavior.