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Mental Health Treatment Seeking Among Older Adults With Depression: The Impact of Stigma and Race

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Objective:

Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need services from seeking care. This study examined the impact of public stigma (negative attitudes held by the public) and internalized stigma (negative attitudes held by stigmatized individuals about themselves) on racial differences in treatment-seeking attitudes and behaviors among older adults with depression.

Method:

Random digit dialing was utilized to identify a representative sample of 248 African American and white older adults (older than 60 years) with depression (symptoms assessed by the Patient Health Questionnaire-9). Telephone-based surveys were conducted to assess their treatment-seeking attitudes and behaviors and the factors that impacted these behaviors.

Results:

Depressed older adult participants endorsed a high level of public stigma and were not likely to be currently engaged in or did they intend to seek mental health treatment. Results also suggested that African American older adults were more likely to internalize stigma and endorsed less positive attitudes toward seeking mental health treatment than their white counterparts. Multiple regression analysis indicated that internalized stigma partially mediated the relationship between race and attitudes toward treatment.

Conclusion:

Stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression, particularly African American elders. Interventions to target internalized stigma are needed to help engage this population in psychosocial mental health treatments.

Section snippets

RACE AND AGE DISPARITIES IN TREATMENT UTILIZATION

African American older adults suffer more psychological distress than their white counterparts due to their lifelong exposure to and experiences with racism, discrimination, prejudice, poverty, and violence8; and they tend to have fewer psychological, social, and financial resources for coping with stress than their white counterparts.9 Despite epidemiologic research, which suggests similar rates of depression among African Americans and whites,5 racial disparities continue to exist in mental

THE IMPACT OF STIGMA

The stigma associated with having a mental illness may be an important factor which influences treatment-seeking attitudes and behaviors and may, in part, account for existing disparities in service utilization among African American older adults. According to Goffman,23 stigma is an identified mark or characteristic, which disqualifies those possessing the mark from full social acceptance in society. This includes the negative perceptions, attitudes, and beliefs held about individuals who bear

Research Design

Study participants were recruited by the University Center for Social and Urban Research at the University of Pittsburgh using random digit dialing telephone sampling methodology. Participants were recruited from Allegheny County (Pittsburgh) PA. To attain a representative sample of both African Americans and whites for this study, the area-code/exchanges were divided into two strata for sampling: 1) exchanges with less than 25% estimated African American population and 2) exchanges with an

RESULTS

Eighty-four percent of the sample was female (N = 207). Participants’ age ranged from 60 to 93 years, with a mean age of 72 years (SD = 7.8). Forty percent of the sample was widowed (N = 112), with the additional 42% either married (N = 54) or divorced (N = 49). Sixty-seven percent of the sample participants were high school graduates (N = 82), had a general equivalency diploma (GED) equivalent (N = 13), or had completed at least some college (N = 73), and 81% (N = 201) of the sample

DISCUSSION

Although many studies have examined the association between race, attitudes about mental health treatment, and treatment-seeking behaviors, to date, very few investigations have addressed the impact of stigma on these relationships. Even fewer have examined these relationships in a sample of older adults with depression. This investigation bridges the gap by presenting data on the impact of stigma and race on the mental health treatment-seeking attitudes and behaviors of older adults with

CONCLUSION

This study examined the impact of stigma on racial differences in treatment-seeking attitudes and behaviors among older adults with depression. Results suggest that although perceived public stigma among older adults is fairly high, African American older adults endorsed higher levels of internalized stigma and less positive attitudes toward seeking mental health treatment than their white counterparts. In addition, high level of internalized stigma was related to more negative attitudes toward

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    The authors thank the men and women who shared their personal experiences in our survey and interviews.

    This work was supported by the John A. Hartford Foundation Dissertation Fellowship (to KOC), University Center for Social and Urban Research University of Pittsburgh, Steven Manners Faculty Development Award (to CB), Center on Race and Social Problems, University of Pittsburgh School of Social Work (to CB), Advanced Center for Interventions and Services Research on Late Life Mood Disorders (P30MH71944; PI: Charles F. Reynolds III, M.D.), and the Commonwealth of Pennsylvania Department of Health (to CFR).

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