Fripp, J. A. and Carlson R. G. (2017). Exploring the influence of attitude and stigma on participation of African American and Latino populations in mental health services. Journal of Multicultural Counseling and Development, 5(2), 85-94.
Although individuals from minority populations in the U.S. experience mental illness at similar rates as white individuals, symptoms are potentially more long-lasting and disabling among minority groups due to a variety of factors. Part of this may be due to difficulty obtaining appropriate mental health care in a timely way. Primarily, the broad context of systemic racism and social barriers that members of minority groups face play a role. Due to disparities in access to healthcare and other resources that promote good mental health, those from minority populations may have more trouble getting mental health care if they desire it. For example, lack of money, lack of health insurance, and inability to take time off of work are practical factors that make it harder to get mental health services. In addition, mistrust of the traditional medical system in our country can reduce the likelihood of care-seeking among African-American and Latinx individuals. Studies show that patients in minority groups experience more negative encounters and less quality care in our healthcare system, and this undoubtedly deters people from getting help. And, in the case of Latinx, language barriers and fear of deportation (for undocumented individuals) may play a role as well.
The authors of this study aimed to look at help-seeking behaviors among African-Americans and Latinx-Americans with a focus on differentiating between the impact of stigma and attitude. This study considers attitude and stigma separately, although they point out that the terms are sometimes used interchangeably when people talk about reasons that many Americans who need it do not seek mental health care. Stigma is defined in this article as the negative appraisal of mental health problems and the people who have them. It originates from external sources (e.g., other people, the media) but can be (and often is) internalized by those who experience mental health problems. Attitude, on the other hand, is an internalized core belief held by an individual that may influence whether or not he/she seeks treatment. One point that is not made clear in the article is the difference between internalized stigma and attitude.
Some discussion about stigma and attitude occurs in the article, but there is an overlap in the constructs which makes studying them separately seem challenging at best. For example, they state that the terms “stigma” and “attitude” are used interchangeably yet go on to refer to definitions of stigma in other literature as “a stereotyping attitude” or “negative perceptions.” While the article does not seem to set the two terms up as distinct constructs, they propose that examining attitude as a specific predictor of help-seeking behavior is needed. Therefore, they propose to look at stigma as “a macrosystem that maintains negative views from people, media, society, and social influences collectively,” and they define attitude as individuals core beliefs. They propose that individuals may have certain attitudes about mental health yet “not subscribe to the stigmatizing value system that shapes the culture of counseling” yet they do not explain how this may occur. Although the authors did not sufficiently explain how the two constructs differ, they sought to look at stigma and attitudes separately among Latino/as and African Americans toward the goal of ultimately improving rates of help-seeking in these populations. Specifically, their stated goal was to separate attitude and stigma as unique predictors of intentions to seek mental health treatment with attitude being examined as a unique predictor of help-seeking.
Specific hypotheses included:
Hypothesis 1: Although, the effect size was small, the results showed that more positive attitudes toward engaging in mental health care were associated with greater intention to seek counseling. Also, as positive attitude increased, so did the number of counseling sessions attended.
Hypothesis 2: The results indicated an inverse relationship between positive attitude toward help-seeking and stigma. In addition, the data reflected that as attitudes toward seeking mental health care become more negative, stigma is increased.
Given that attitudes and stigma may differ among minority populations, the aims of this study are important since understanding these constructs among Latinx and African-Americans may help to create better pathways to treatment. However, the overlap between the constructs of attitude and stigma seems to be problematic as measured in the study. In fact, one of the four content areas for the measure of attitude used reflects stigma itself. In the authors’ assessment as to the reason for the weak association between positive attitudes and greater intention to seek counseling, they suggest that there may be other salient variables that deter individuals from Latinx and/or African-American backgrounds from seeking care. Examples given include a possible lack of understanding about the “benefits or the nature of counseling,” and what this means is not exactly clear. Likely, the larger societal variables of healthcare disparities and mistrust of the medical system in general play a larger role. A helpful addition to the study would have been a measure to assess attitudes toward seeking mental health care that included some assessment of the culturally-specific concerns faced by people from non-dominant groups (e.g., “I do/do not have confidence that my mental health provider will consider cultural factors in assessing and treating my mental health concerns).
The second hypothesis seems self-explanatory, and the authors note that perhaps Latinx and African-Americans have more negative attitudes about mental health care due to fear of discrimination and unfair treatment—a finding that has been reported in other literature. However, the measure used to assess stigma seems to specifically inquire about self-stigma rather than a broader construct, and, again, it is hard to differentiate self-stigma from attitude without more information.
Important take-aways from the article include the finding that, among Latinx and African-Americans, a more positive attitude toward seeking mental health care is associated with greater intent to do so. Also, attitude toward seeking mental health care and stigma are inversely related. In future studies, it will be helpful to learn more about culturally-specific factors at play regarding attitude and stigma so that specific aims may be developed to build positive attitudes about help-seeking among Latinx and African-American groups. For example, if a culturally-specific attitude among Latinx is that spiritual measures to address problems are more appropriate/acceptable, public health efforts encouraging this group toward mental health treatment may need to incorporate faith-based components and/or references. While we cannot generalize about the attitudes and preferences of different groups, building on what we know about attitudes toward mental health can be an important advancement to help people from all backgrounds receive mental health care.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Dr. Regina Shillinglaw is a deployment behavioral health psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Located at Wright Patterson Medical Center in Ohio, she is a faculty member and the assistant training director in the APA-approved pre-doctoral psychology internship training program.