The interplay of etiological knowledge and mental illness stigma on healthcare utilisation in the community: A structural equation model

N Schnyder; C Michel; R Panczak; S Ochsenbein; B G Schimmelmann; F Schultze-Lutter

doi:10.1016/j.eurpsy.2017.12.027

The interplay of etiological knowledge and mental illness stigma on healthcare utilisation in the community: A structural equation model

Eur Psychiatry. 2018 Jun:51:48-56. doi: 10.1016/j.eurpsy.2017.12.027. Epub 2018 Mar 6.

Authors

N Schnyder¹, C Michel², R Panczak³, S Ochsenbein⁴, B G Schimmelmann⁵, F Schultze-Lutter⁶

Affiliations

¹ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. Electronic address: nina.schnyder@upd.unibe.ch.
² University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁴ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
⁵ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁶ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.

PMID: 29518618
DOI: 10.1016/j.eurpsy.2017.12.027

Abstract

Background: The stigma of mental illness, especially personal attitudes towards psychiatric patients and mental health help-seeking, is an important barrier in healthcare utilisation. These attitudes are not independent of each other and are also influenced by other factors, such as mental health literacy, especially the public's causal explanations for mental problems. We aimed to disentangle the interrelations between the different aspects of stigma and causal explanations with respect to their association with healthcare utilisation.

Methods: Stigma and causal explanations were assessed cross-sectional using established German questionnaires with two unlabelled vignettes (schizophrenia and depression) in a random-selection representative community sample (N = 1375, aged 16-40 years). They were interviewed through a prior telephone survey for current mental disorder (n = 192) and healthcare utilisation (n = 377). Structural equation modelling was conducted with healthcare utilisation as outcome and stigma and causal explanations as latent variables. The final model was additionally analysed based on the vignettes.

Results: We identified two pathways. One positive associated with healthcare utilisation, with high psychosocial stress and low constitution/personality related causal explanations, via positive perception of help-seeking and more help-seeking intentions. One negative associated with healthcare utilisation, with high biogenetic and constitution/personality, and low psychosocial stress related explanations, via negative perception of psychiatric patients and a strong wish for social distance. Sensitivity analysis generally supported both pathways with some differences in the role of biogenetic causal explanation.

Conclusion: Our results indicate that campaigns promoting early healthcare utilisation should focus on different strategies to promote facilitation and reduce barriers to mental healthcare.

Keywords: Attitudes; Help-seeking; Mental health literacy; Mental problems; Stigma.

MeSH terms

Adolescent
Adult
Causality
Cross-Sectional Studies
Depression* / epidemiology
Depression* / psychology
Depression* / therapy
Female
Health Literacy
Help-Seeking Behavior*
Humans
Latent Class Analysis
Male
Mental Health / statistics & numerical data*
Needs Assessment
Patient Acceptance of Health Care / statistics & numerical data*
Psychological Distance
Schizophrenia* / epidemiology
Schizophrenia* / therapy
Schizophrenic Psychology
Social Stigma*
Switzerland / epidemiology