Examining between- and within-person effects of the self-stigma of seeking psychological help on the therapeutic working alliance: The moderating role of psychological distress.

The self-stigma (i.e., shame) associated with psychotherapy is a prominent barrier to seeking psychological help, but less is known about its effects after treatment begins. Evidence suggests that self-stigma may interfere with the formation of the therapeutic alliance, but no studies have examined this throughout the course of psychotherapy. Self-stigma's erosion of the alliance may be most pronounced when clients experience heightened psychological distress, but this also has not been examined. Therefore, the present study addresses these omissions among 37 clients who completed at least three therapy sessions for research credit. Participants completed measures of self-stigma and past-week symptoms of distress before each session and ratings of the working alliance after. Predictor variables were disaggregated into between-person (time-invariant or average levels) and within-person (time-variant or session-by-session changes) components to enable investigation of for whom (and under what conditions) self-stigma was associated with the therapeutic alliance. Results indicated that higher levels of self-stigma (between and within persons) predicted a worse alliance. When examined as an interaction effect alongside distress in a multilevel moderation model, higher between-person ratings of self-stigma predicted a weaker therapist-client alliance across levels (M ± 1 SD) of within-person distress. Notably, its effects became more pronounced as symptoms of distress increased, indicating a period in which clients are simultaneously most likely to need help yet least likely to feel allied with their therapist. Findings highlight the importance for therapists to simultaneously monitor and consider both average and session-by-session fluctuations in self-stigma and distress to develop and maintain the working alliance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-reliance, Social Norms, and Self-stigma as Barriers to Psychosocial Help-Seeking Among Rural Cancer Survivors With Cancer-Related Distress: Qualitative Interview Study.

BACKGROUND: Even when technology allows rural cancer survivors to connect with supportive care providers from a distance, uptake of psychosocial referrals is low. Fewer than one-third of participants in a telemedicine intervention for identifying rural survivors with high distress and connecting them with care accepted psychosocial referral. OBJECTIVE: The purpose of this research was to examine the reasons for which rural cancer survivors did not accept a psychosocial referral. METHODS: We utilized a qualitative design to address the research purpose. We interviewed participants who had been offered psychosocial referral. Semistructured interviews were conducted 6 weeks later (n=14), and structured interviews were conducted 9 months later (n=6). Data were analyzed descriptively using an inductive approach. RESULTS: Ultimately, none of the rural cancer survivors (0/14, 0%) engaged with a psychosocial care provider, including those who had originally accepted referrals (0/4, 0%) for further psychosocial care. When explaining their decisions, survivors minimized their distress, emphasizing their self-reliance and the need to handle distress on their own. They expressed a preference for dealing with distress via informal support networks, which was often limited to close family members. No survivors endorsed public stigma as a barrier to accepting psychosocial help, but several suggested that self-stigma associated with not being able to handle their own distress was a reason for not seeking care. CONCLUSIONS: Rural cancer survivors' willingness to accept a psychosocial referral may be mediated by the rural cultural norm of self-reliance and by self-stigma. Interventions to address referral uptake may benefit from further illumination of these relationships as well as a strength-based approach that emphasizes positive aspects of the rural community and individual self-affirmation.

Measurement Invariance of the Self-Stigma of Mental Illness Scale: A Cross-Cultural Study.

The current study assessed the measurement invariance of the Self-stigma of Mental Illness scale (SSOMI) across Chinese and US samples and assessed whether the SSOMI differentially relates to distress levels across Chinese and US participants. We included 487 participants in China and 550 in the US (mean age was 19.52 in China and 19.29 in the US). The results indicated that partial measurement invariance of the SSOMI scale across China and the United States participants was established. Furthermore, we observed validity evidence for the SSOMI scale through its correlations with a well-established self-stigma measure and measures of depression, anxiety, and stress. Finally, we found that the SSOMI scale is more strongly linked to symptoms of depression, anxiety, and stress in China than it is in the United States, supporting previous research. These findings enable researchers to utilize the scale cross-culturally (i.e., with participants of Chinese and US origin), and to develop and implement interventions targeting mental illness stigma in both China and the United States.

Examination of a distress screening intervention for rural cancer survivors reveals low uptake of psychosocial referrals.

PURPOSE: To determine the impact of a telemedicine-delivered intervention aimed at identifying unmet needs and cancer-related distress (CRD) following the end of active treatment on supportive care referral patterns. METHODS: We used a quasi-experimental design to compare supportive care referral patterns between a group of rural cancer survivors receiving the intervention and a control group (N = 60). We evaluated the impact of the intervention on the number and type of referrals offered and whether or not the participant accepted the referral. CRD was measured using a modified version of the National Comprehensive Cancer Network Distress Thermometer and Problem List. RESULTS: Overall, 30% of participants received a referral for further post-treatment supportive care. Supporting the benefits of the intervention, the odds of being offered a referral were 13 times higher for those who received the intervention than those in the control group. However, even among the intervention group, only 28.6% of participants who were offered a referral for further psychosocial care accepted. CONCLUSIONS: A nursing telemedicine visit was successful in identifying areas of high distress and increasing referrals. However, referral uptake was low, particularly for psychosocial support. Distance to care and stigma associated with seeking psychosocial care may be factors. Further study to improve referral uptake is warranted. IMPLICATIONS FOR CANCER SURVIVORS: Screening for CRD may be inadequate for cancer survivors unless patients can be successfully referred to further supportive care. Strategies to improve uptake of psychosocial referrals is of high importance for rural survivors, who are at higher risk of CRD.

Measurement invariance of suicide screening measures across military branch.

Military suicide rates are near all-time highs. To help clinicians and researchers study suicide risk factors in military samples, the Military Suicide Research Consortium (MSRC) developed a set of brief suicide-risk screening measures. While previous research has examined the reliability of these screening measures, it remains unclear if measurement differences exist across different military branches. This is an important omission given that establishing measurement equivalence or invariance (ME/I) across groups is a prerequisite for making group comparisons, which are necessary for accurately identifying and effectively intervening with groups at heightened risk. This study examined the ME/I of four MSRC screening measures (e.g., Depressive Symptom Index - Suicidality Subscale; Interpersonal Needs Questionnaire; Suicidal Behaviors Questionnaire - Revised; Suicide Intent Scale) using a sample of 4,487 participants across military branches (Army; National Guard; Navy; Marine; Air Force) using a series of multiple-group confirmatory factor analyses (MGCFA). We assessed configural, threshold, and loading invariance, with results indicating that the brief screening measures are fully invariant between individuals from different military branches and that these suicide screeners can be used to examine differences across branches in future research. Research and applied implications are discussed.

Examining the Dimensionality, Reliability, and Invariance of the Depression, Anxiety, and Stress Scale-21 (DASS-21) Across Eight Countries.

This study evaluated the dimensionality, invariance, and reliability of the Depression, Anxiety, and Stress Scale-21 (DASS-21) within and across Brazil, Canada, Hong Kong, Romania, Taiwan, Turkey, United Arab Emirates, and the United States (N = 2,580) in college student samples. We used confirmatory factor analyses to compare the fit of four different factor structures of the DASS-21: a unidimensional model, a three-correlated-factors model, a higher order model, and a bifactor model. The bifactor model, with three specific factors (depression, anxiety, and stress) and one general factor (general distress), presented the best fit within each country. We also calculated ancillary bifactor indices of model-based dimensionality of the DASS-21 and model-based reliability to further examine the validity of the composite total and subscale scores and the use of unidimensional modeling. Results suggested the DASS-21 can be used as a unidimensional scale. Finally, measurement invariance of the best fitting model was tested across countries indicating configural invariance. The traditional three-correlated-factors model presented scalar invariance across Canada, Hong Kong, Romania, Taiwan, and the United States. Overall, these analyses indicate that the DASS-21 would best be used as a general score of distress rather than three separate factors of depression, anxiety, and stress, in the countries studied.

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.

An examination of help-seeking preferences via best-worst scaling.

OBJECTIVE: This study utilized best-worst scaling and latent class analysis to assess mental health treatment preferences and identify subgroups of college student help seekers. METHOD: College students (N = 504; age: M = 20.3, 79.2% female) completed assessments of mental health treatment preferences, self-stigma, and distress. RESULTS: Students preferred utilizing friends and family, followed by professional mental health providers, self-help, keeping concerns to themselves, physicians, and lastly religious leaders. Latent class analyses identified four classes of respondents. CONCLUSIONS: Subgroups of student help seekers include Formal Help Seekers who prefer professional mental health providers, Informal Help Seekers who prefer friends and family, Ambivalent Help Seekers who prefer family and friends but also keeping concerns to themselves, and Help Avoiders who prefer keeping concerns to themselves. Assessing treatment preferences among different student subgroups may constitute an initial step in identifying effective ways to address university-wide mental health concerns.

Age differences in public stigma, self-stigma, and attitudes toward seeking help: A moderated mediation model.

OBJECTIVE: Stigma is commonly identified as a key reason that older adults are especially unlikely to seek mental health services, although few studies have tested this assumption. Our objectives were to: (a) examine age differences in public and self-stigma of seeking help, and attitudes toward seeking help, and (b) see whether age moderates an internalized stigma of seeking help model. METHODS: A total of 5,712 Canadians ranging in age from 18 to 101 completed self-report measures of public stigma of seeking help, self-stigma of seeking help, and help-seeking attitudes. RESULTS: Older participants had the lowest levels of stigma and the most positive help-seeking attitudes. Age also moderated the mediation model, such that the indirect effect of public stigma on help-seeking attitudes through self-stigma was strongest for older participants. CONCLUSION: Our findings have implications for the influence of stigma and attitudes as barriers to treatment across the adult lifespan, and for stigma reduction interventions.

How Medical Students' Compassionate Values Influence Help-Seeking Barriers.

THEORY: Despite high rates of psychiatric illnesses, medical students and medical professionals often avoid psychological help. Stigma may prevent medical students from seeking psychological help when experiencing distress, which may hinder their job performance and mental health. Compassionate values-preferred principles that guide attitudes and behaviors to focus on the wellness of others-may be a relevant predictor of medical students' perceptions of psychological help. The present study examined the association between medical students' compassionate values, help-seeking stigma, and help-seeking attitudes in a convenience sample of medical students. HYPOTHESES: Rating compassionate values as more important than self-interested values will be associated with less stigma, which in turn will be associated with more positive help-seeking attitudes. METHOD: There were 220 medical students in their 2nd year of medical training who were recruited in-class and through e-mail between January and March of 2017 at Des Moines University. Students were provided an anonymous online link to a survey composed of validated measures assessing values, psychological distress, and stigma and attitudes related to psychological help. RESULTS: The survey response rate was 41%, leaving a final sample of 91. For every 1 SD increase in the relative importance of compassionate values over self-interested values, help-seeking stigma decreased 0.40 SDs, and help-seeking attitudes increased 0.23 SDs. CONCLUSIONS: Prioritizing compassionate values more strongly than self-interested values is associated with medical students' perceiving psychological help-seeking more positively.

Reducing threat responses to help-seeking information: Influences of self-affirmations and reassuring information.

This research was an examination of the effects of two types of self-affirmation interventions in reducing threat responses associated with receiving help-seeking information. Help-seeking information can be threatening to one's positive self-perceptions and people may avoid seeking such information to protect themselves. There is evidence that reflecting on personal values (values affirmation) may bolster self-integrity and mitigate this avoidance, and it is possible that reflecting on safe, close social relationships (social affirmation) could exhibit similar effects. To experimentally examine this theoretical idea, we applied a 2 × 2 × 2 factorial design in the present study on 384 participants and experimentally manipulated their values affirmations (values affirmation vs. no values affirmation) and social affirmations (social affirmation vs. no social affirmation). In addition, because there is no consensus as to the most effective presentation of help-seeking information, the type of help-seeking information presented to potential help-seekers was also manipulated (reassuring help-seeking information vs. nonreassuring help-seeking information). Results indicated that values affirmation and reassuring information were linked to lower threat responses, but social affirmation was not. Values affirmation and reassuring information might be effective strategies for reducing threat responses associated with the presentation of psychological help-seeking information. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Self-affirming values to increase student veterans' intentions to seek counseling.

Student veterans experiencing mental health concerns could benefit from seeking counseling (Rudd, Goulding, & Bryan, 2011), though they often avoid these services. Self-affirmation interventions have been developed to increase openness to health-related behaviors (Sherman & Cohen, 2006), and may also help promote psychological help-seeking intentions. This study explored whether a self-affirmation intervention increased intentions to seek counseling in a sample of 74 student veterans who had not previously sought counseling services. Participants completed pretest (Time 1) measures of distress and help seeking (i.e., self-stigma, attitudes, and intentions to seek counseling). A week later (Time 2), participants completed one of two conditions: (1) a self-affirmation intervention before viewing a psychoeducational video and brochure or (2) only the psychoeducational video and brochure before completing the same help-seeking measures as Time 1. A week after the intervention (Time 3), participants again completed the help-seeking measures. A focused longitudinal mediation model was conducted, examining the effect of the self-affirmation experimental condition on help-seeking intentions. Compared with those in the psychoeducation-only group, student veterans who completed the self-affirmation intervention reported increased intentions to seek counseling both immediately postintervention (Time 2) and a week later (Time 3). (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Do self-compassion and self-coldness distinctly relate to distress and well-being? A theoretical model of self-relating.

The current research tested a theoretical model of self-relating that examined the unique relationships of self-compassion and self-coldness with distress and well-being. Self-coldness has recently been identified as theoretically distinct from self-compassion, rather than part of a unitary self-compassion construct. As such, the incremental value of self-compassion and self-coldness on clinically relevant outcomes is unclear. Therefore, the current research tested a theoretical model of the unique relationships of self-compassion and self-coldness and both distress and well-being among university students (N = 457) and community adults (N = 794), as well as interactions between these 2 constructs. Structural equation modeling results in both samples revealed that self-compassion was uniquely related to well-being (ßs = .36-.43), whereas self-coldness was uniquely related to distress (ßs = -.34) and well-being (ßs = .65-.66). Consistent with the Theory of Social Mentalities, across samples self-compassion more strongly related to well-being, whereas self-coldness more strongly related to distress. Self-compassion did not demonstrate a unique direct relationship with distress, but it did buffer the relationship between self-coldness and distress in both samples and the relationship between self-coldness and well-being in the community sample. Overall, results suggest that clinicians would benefit from tailoring the use of self-compassion and self-coldness interventions. Implications for future research and practice are discussed. (PsycINFO Database Record

Two is more valid than one: Examining the factor structure of the Self-Compassion Scale (SCS).

The Self-Compassion Scale (SCS; Neff, 2003a) is the most widely used measure of self-compassion. Self-compassion, as measured by the SCS, is robustly linked to psychological health (Macbeth & Gumley, 2012; Zessin, Dickhaüser, & Garbade, 2015). The SCS is currently understood as exhibiting a higher-order structure comprised of 6 first-order factors and 1 second-order general self-compassion factor. Recently, some researchers have questioned the internal validity of this 1-factor conceptualization, and posit that the SCS may instead be comprised of 2 general factors-self-compassion and self-coldness. The current paper provides an in-depth examination of the internal structure of the SCS using oblique, higher-order, and bifactor structural models in a sample of 1,115 college students. The bifactor model comprised of 2 general factors-self-compassion and self-coldness-and 6 specific factors demonstrated the best fit to the data. Results also indicated the Self-Coldness factor accounted for unique variance in depression, anxiety, and stress, whereas the Self-Compassion factor only accounted for unique variance in its association with depression, providing further evidence for the presence of 2 distinct factors. Results did not provide support for the 1-factor composition of self-compassion currently used in research. Implications for using, scoring, and interpreting the SCS are discussed. (PsycINFO Database Record

Can reflecting on personal values online increase positive beliefs about counseling?

This research developed and tested an online values-affirmation exercise to attenuate threat and enhance positive beliefs about counseling among individuals struggling with mental health concerns. There is evidence that reflecting on personal values (values-affirmation) is an effective approach to eliciting self-affirmation-a psychological process that temporarily bolsters self-worth in order to forestall maladaptive, self-protective responses to counseling information. The present study utilized a randomized 2-group between-subjects design to test the effectiveness of a values-affirmation exercise with an online sample (N = 186) of adults who reported struggling with a mental health concern. It was predicted that values-affirmation would reduce threat related to reading mental health information and increase positive beliefs about counseling. Results indicated that those in the values-affirmation condition reported fewer negative emotions such as feeling upset, irritable, hostile, and scared after reading mental health information, indicating that the information was perceived as less threatening. There was also evidence that engaging in values-affirmation was associated with greater anticipated growth in counseling and greater intent to seek counseling, reflecting greater positive beliefs about counseling. Overall, the results suggest that reflecting on personal values may have the potential to enhance the positive effects of online psychoeducation. (PsycINFO Database Record

Masculinity and barriers to seeking counseling: The buffering role of self-compassion.

Less than 1/3 of college men seek psychological help per year when experiencing mental health concerns. Many believe this is because socialized masculine norms are incongruent with help-seeking decisions. In line with this, adherence to masculine norms, like emotional control and self-reliance, is consistently linked to factors associated with lower use of counseling. Identifying constructs that buffer, or reduce, the relationship between masculine norm adherence and common barriers to seeking help, like help-seeking self-stigma and resistance to self-disclosing, could shed light on mechanisms through which effective interventions could be developed. As such, this study examined whether self-compassion, or the ability to show oneself kindness and understanding in the face of challenges, moderated the relationship between masculine norm adherence and both help-seeking self-stigma and the risks associated with self-disclosing to a counselor in a sample of 284 undergraduate men (Mage = 19.68, range = 18-30). Results indicate that self-compassion is associated with lower levels of help-seeking self-stigma and disclosure risks. Additionally, and perhaps more importantly, self-compassion buffered the relationship between overall masculine norm adherence and each of these barriers. Furthermore, when specific masculine norms were examined, self-compassion buffered the relationship between emotional control and disclosure risks. These results support the need for future research focused on the development and assessment of self-compassion based interventions aimed at decreasing the barriers undergraduate men experience toward seeking psychological help. (PsycINFO Database Record

Evidências de validade da escala PSOSH: estigmatização e procura de ajuda psicológica / Evidences of validity for PSOSH scale: stigmatization and seeking psychological help

O estigma é uma variável de importante relevância em saúde mental, o que torna sua mensuração indispensável à prática profissional. Este estudo objetivou buscar evidências de validade com base na estrutura interna para a escala PSOSH. Participaram da pesquisa 275 estudantes universitários da área de Psicologia, dos quais 82,4% eram do sexo feminino e a idade variou de 18 a 54 anos. Verificou-se que a PSOSH apresentou ótimo valor para alfa de Cronbach. Os itens tiveram cargas fatoriais superiores a 0,5 e variância explicada de 62,9% para um fator. Índices Infit, Outfit e da CCI adequados. Estes resultados ratificam as qualidades psicométricas adequadas para utilização da escala na prática profissional e recomendam-se pesquisas com grupos de distintas condições clínicas.(AU)

Stigma is a relevant variable in mental health care and for professional practice. This study aimed to find evidences of validity based on internal structure to scale PSOSH. Participated of that study 275 college students, which 82.4% female, aged 18-54 years and various levels of academic degree in Psychology. We used exploratory factor analysis (EFA) to analyze the factor structure. The results for PSOSH show great value for alpha consistency, the items had factor loadings greater than 0.5 and 62.9% of variance explained by one factor (EFA) and those show suitable indices for Infit, Outfit and CCI. These results confirm those appropriate psychometric properties for use in professional practice and it suggests further researches with clinical groups.(AU)

Evidências de validade da escala PSOSH: estigmatização e procura de ajuda psicológica / Evidences of validity for PSOSH scale: stigmatization and seeking psychological help

O estigma é uma variável de importante relevância em saúde mental, o que torna sua mensuração indispensável à prática profissional. Este estudo objetivou buscar evidências de validade com base na estrutura interna para a escala PSOSH. Participaram da pesquisa 275 estudantes universitários da área de Psicologia, dos quais 82,4% eram do sexo feminino e a idade variou de 18 a 54 anos. Verificou-se que a PSOSH apresentou ótimo valor para alfa de Cronbach. Os itens tiveram cargas fatoriais superiores a 0,5 e variância explicada de 62,9% para um fator. Índices Infit, Outfit e da CCI adequados. Estes resultados ratificam as qualidades psicométricas adequadas para utilização da escala na prática profissional e recomendam-se pesquisas com grupos de distintas condições clínicas.

Stigma is a relevant variable in mental health care and for professional practice. This study aimed to find evidences of validity based on internal structure to scale PSOSH. Participated of that study 275 college students, which 82.4% female, aged 18-54 years and various levels of academic degree in Psychology. We used exploratory factor analysis (EFA) to analyze the factor structure. The results for PSOSH show great value for alpha consistency, the items had factor loadings greater than 0.5 and 62.9% of variance explained by one factor (EFA) and those show suitable indices for Infit, Outfit and CCI. These results confirm those appropriate psychometric properties for use in professional practice and it suggests further researches with clinical groups.

Does self-stigma reduce the probability of seeking mental health information?

An important first step in seeking counseling may involve obtaining information about mental health concerns and treatment options. Researchers have suggested that some people may avoid such information because it is too threatening due to self-stigma and negative attitudes, but the link to actual help-seeking decisions has not been tested. Therefore, the purpose of the present study was to examine whether self-stigma and attitudes negatively impact decisions to seek information about mental health concerns and counseling. Probit regression models with 370 undergraduates showed that self-stigma negatively predicted decisions to seek both mental health and counseling information, with attitudes toward counseling mediating self-stigma's influence on these decisions. Among individuals experiencing higher levels of distress, the predicted probabilities of seeking mental health information (8.5%) and counseling information (8.4%) for those with high self-stigma were nearly half of those with low self-stigma (17.1% and 15.0%, respectively). This suggests that self-stigma may hinder initial decisions to seek mental health and counseling information, and implies the need for the development of early interventions designed to reduce help-seeking barriers.

Factor Structure of the Gender Role Conflict Scale-Short Form in Chinese Heterosexual and Gay Samples.

The current study examined the validity of Gender Role Conflict Scale-Short Form (GRCS-SF) among a sample of 256 Chinese heterosexual men and 250 Chinese gay men. Confirmatory factor analysis (CFA) supported the conclusion that a Chinese translated version of the GRCS-SF had acceptable structural validity. Specifically, the four-factor solution (i.e., Success, Power, Competition; Restricted Emotionality; Restricted Affectionate Behavior Between Men; Conflict Between Work and Family Relations) was confirmed with all items loading on their respective factors. Furthermore, the four-factor solution provided a better fit than either a single factor or a four-factor solution with a higher-order single factor. Cronbach's α reliabilities reached the acceptable criterion in both samples for the overall score as well as for the subscale scores. Measurement invariance also suggested that the GRCS-SF has a similar structure between heterosexual and gay Chinese men.