Research That Matters (January 17 - 20, 2008)

Purpose. Research examining racial differences in attitudes toward mental health treatment has had inconsistent findings. Some studies suggest that, in general, African Americans have less positive attitudes toward mental health services than their white counterparts, while others suggest no differences, and still others suggest African Americans have more positive attitudes toward treatment. There is a dearth of research examining the links between race and attitudes toward seeking mental health treatment among older adults. Additionally, little empirical work has addressed the association between stigma and racial differences in attitudes toward mental health treatment. The primary aim of this study is to test the hypothesis that stigma partially mediates the relationship between race and attitudes towards seeking mental health services.

Methods. Study participants were 48 African American and 51 white older adults, age 60 and over, who were recruited from three community-based independent living facilities in Pittsburgh, PA. The sample was predominately female (66.7%) and the average age was 68 (SD 9.2). After signing an informed consent form, the participants completed a survey for which they received $5. The survey instrument included: demographic questions and well-established measures of public stigma, internalized stigma and attitudes toward mental health treatment.

Results. Older African Americans in this sample were more likely to endorse negative attitudes toward mental health services (t = 5.454 (97), p<.001) than their white counterparts. In addition, African Americans were more likely to report high levels of public stigma (t = -4.153 (97), p<.001) and internalized stigma (t = -3.385 (96), p=.004) than their white counterparts. Further, both public stigma (r =-.786, p<.001) and internalized stigma (r = -.855, p<.001) were highly and significantly correlated with attitudes toward seeking mental health services. Baron and Kenny's (1986) four-step multiple regression analysis approach to test for mediation was utilized to determine whether stigma (public stigma and/or internalized stigma) partially mediates the relationship between race and attitudes toward mental health treatment. As hypothesized, results of the statistical mediation tests indicate that internalized stigma partially mediates the relationship between race and attitudes toward mental health treatment (Sobel= 3.97, p<.001). However, the indirect effect of public stigma was insignificant.

Implications. This study demonstrates the development of a promising partial mediation model that suggests how stigma is likely to impact attitudes toward treatment for both older African Americans and whites. It is important for social workers to recognize the impact of stigma on attitudes toward treatment seeking, particularly the effect of internalized stigma. If these results are replicated in future findings, strategies for decreasing internalized stigma need to be developed. Reduction of internalized stigma can be addressed as a treatment goal, or as the target of pre-treatment engagement intervention. If we can target and reduce internalized stigma in clinical settings, we will likely improve client attitudes toward mental health treatment and, hopefully, increase their treatment-seeking behavior.