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

Purpose. Empirical investigation suggests the stigma of having a mental health diagnosis may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with depression. There is, however, a dearth of research that examines the way in which stigma influences attitudes toward seeking mental health services among aging populations and racial/ethnic minorities. Utilizing a cross-section survey design with a representative sample of 248 older adults, this study aims to investigate the impact of the stigma associated with mental illness on treatment seeking attitudes and behaviors among older adults with depression, and to identify modifiable factors related to stigma associated with depression that can be utilized to develop culturally competent interventions to decrease stigma in aging populations.

Methods. Study participants included 248 older adults (120 African American and 128 white) with at least mild depression symptoms who scored 5 or above on the Patient Health Questionnaire (PHQ). Eighty four percent (n=207) of the sample was female. Participants' age ranged from 60 to 93 years old, with a mean of 72 (SD= 7.8). Participants completed the survey via telephone, and received $15 for their time. The survey instrument included: demographics, questions about treatment utilization, and well-established measures of public stigma, internalized stigma and attitudes toward mental health treatment.

Results. The majority of participants (73%) endorsed moderate to severe depression symptoms, however most study participants (56%) had never seen a mental health professional for treatment, less than 16% of participants were currently in treatment and only 18% stated that they were likely to seek mental health treatment in the future. As predicted, African American older adults had more negative attitudes about mental health treatment (t(246)= 2.790, p =.006) and experienced more internalized stigma (t(246)= -2.118, p =.035) than their white counterparts. Additionally, internalized stigma was related to more negative attitudes about mental health treatment (r = -.253, p<.01), and in fact partially mediated the relationship between race and attitudes about mental health treatment (Sobel = 2.07, p<.05). Further, positive attitude about mental health treatment was related to higher intention to seek treatment (r= .132, p<.05) and high intention to seem mental health treatment was related to higher engagement in treatment (r= .281, p<.01). Findings also suggest that both African American and white older adults experience a great deal of public and internalized stigma, and have moderately negative attitudes about seeking mental health treatment, which impacts the low utilization rates of mental health treatment for this population.

Implications. This study presents the development of a promising partial mediation model that suggests how stigma impacts attitudes toward treatment. Social workers must recognize the impact of internalized stigma on attitudes toward treatment, and develop effective stigma reduction engagement interventions. Reduction of internalized stigma can be addressed as a treatment goal, and the engagement intervention. If we target and reduce internalized stigma in clinical settings, we will likely improve attitudes toward treatment and increase the treatment-seeking behavior of older adults with depression.

Project Funded by Hartford Dissertation Fellowship