Objectives: To determine the prevalence and sociodemographic correlates of negative attitudes toward help seeking for mental illness among the general population in the United States and Ontario.
Methods: Two contemporaneous population-based surveys (aged 15 to 54 years) were analyzed: the US National Comorbidity Survey (NCS) (n = 5877) and the Ontario Health Survey (OHS) (n = 6902). Multiple logistic regression analyses were used to examine the correlates of a derived negative attitudes composite variable obtained from questions assessing probability, comfort, and embarrassment related to help seeking for mental illness.
Results: Negative attitudes toward help seeking for mental illness were prevalent in both countries. Fifteen percent of OHS and 20% of NCS respondents stated they probably or definitely would not seek treatment if they had serious emotional problems. Almost one-half of recipients in both surveys stated they would be embarrassed if their friends knew about their use of mental health services. Negative attitudes toward help seeking were highest among socioeconomically challenged young, single, lesser-educated men in Ontario and the United States. In both countries, substance abuse or dependence and antisocial personality disorder were associated with greater negative attitudes, as was not having sought treatment in the past.
Conclusions: Negative attitudes toward mental health service use are prevalent in Ontario and the United States. They are most common in young adults, especially those with lower education and socioeconomic resources, and those with substance abuse or dependence problems. This information can be used to target educational efforts aimed at improving willingness to seek care for mental health problems.
Can J Psychiatry. 2009;54(11):757-766.
* Negative attitudes toward mental health service use are prevalent in the community.
* Young, single, socioeconomically challenged men with a mental disorder have the poorest attitudes toward mental health services.
* There is a need for targeted screening and intervention programs in young adults.
* The measurement of attitudes was brief.
* The surveys were collected in the early 1990s, and some of these findings might have changed over time.
* Mental disorders were assessed by lay interview-based diagnoses rather than by clinicians.
Key Words: negative attitudes, mental illness, help seeking, mental disorders, United States, Canada
Abbreviations used in this article
CCHS 1.2 Canadian Community Health Survey: Mental Health and Well-Being
CIDI Composite International Diagnostic Interview
DSM Diagnostic and Statistical Manual of Mental Disorders
MHS Mental Health Supplement
NCS National Comorbidity Survey
OHS Ontario Health Survey
PTSD posttraumatic stress disorder
WMH World Mental Health
Psychopathology has been well established regarding disability and costs to society yet untreated mental illness remains a significant problem.1 The World Health Organization's WMH Survey Consortium reported on the prevalence and treatment of mental disorders across 14 countries.2 The proportion of people meeting criteria for having at least 1 DSM-IV disorder assessed ranged from 4.3% to 26.4%. However, people receiving any treatment for emotional problems during the 12 months prior to the WMH surveys ranged from 0.8% to 1 5.3%.2 Despite the availability of effective treatment regimens for most mental disorders, only a fraction receive appropriate care each year.3 The WMH investigation confirmed numerous earlier findings that untreated mental illness remains a significant problem across the world.2'4,5
Attitudes Toward Help Seeking
Andersen's6 behavioural model of health services use is commonly employed in the broader help-seeking literature as a guiding theoretical model. …