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Age, gender, and the underutilization of mental health services: The influence of help-seeking attitudes
Abstract
The objectives of this study were to explore age and gender differences in attitudes toward seeking professional psychological help, and to examine whether attitudes negatively influence intentions to seek help among older adults and men, whose mental health needs are underserved. To achieve these objectives 206 community-dwelling adults completed questionnaires measuring help-seeking attitudes, psychiatric symptomatology, prior help-seeking, and intentions to seek help. Older age and female gender were associated with more positive help-seeking attitudes in this sample, although age and gender interacted with marital status and education, and had varying influences on different attitude components. Age and gender also influenced intentions to seek professional psychological help. Women exhibited more favourable intentions to seek help from mental health professionals than men, likely due to their positive attitudes concerning psychological openness. Older adults exhibited more favourable intentions to seek help from primary care physicians than younger adults, a finding that was not explained by age differences in attitudes. Results from this study suggest that negative attitudes related to psychological openness might contribute to men's underutilization of mental health services. Help-seeking attitudes do not appear to be a barrier to seeking professional help among older adults, although their intentions to visit primary care physicians might be. These findings suggest the need for education to improve men's help-seeking attitudes and to enhance older adults' willingness to seek specialty mental health services.
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“Men are rarely socialized to be open about their emotional troubles; which in turn was found to contribute to their underutilization of mental health services (Mackenzie, Gekoski, Knox, 2006).”
From The Disclosure Experiences of Male Child Sexual Abuse Survivors (2016) · cites this paper as Mackenzie, Gekoski, Knox, 2006
In the citing paper
“Compared to women, men are less likely to seek help for mental health difficulties.”
From Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking (2019) · cites this paper as Mackenzie, Gekoski, & Knox, 2006
In the citing paper
“Although help-seeking is consistently reported to be worse in males (Mackenzie et al., 2006), the identified techniques in this review should be interpreted cautiously.”
From Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking (2019) · cites this paper as Mackenzie et al., 2006
In the citing paper
“Although help-seeking is consistently reported to be worse in males (Mackenzie et al., 2006), the identified techniques in this review should be interpreted cautiously.”
From Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking (2019) · cites this paper as Mackenzie et al., 2006
In the citing paper
“Low educational status might be associated with low rates of help-seeking because educated individuals are more informed and knowledgeable about illnesses and the healthcare system”
From A systematic review of the factors associated with delays in medical and psychological help-seeking among men (2015) · cites this paper as Mackenzie, Gekoski, & Knox, 2006
In the citing paper
“The reason why younger men seek less help may partly be an artefact of their lower levels of illness, and partly due to the fact that their vitality and masculinity is more important to them”
From A systematic review of the factors associated with delays in medical and psychological help-seeking among men (2015) · cites this paper as Mackenzie, Gekoski, & Knox, 2006
In the citing paper
“Young men are known to hold more negative attitudes towards help-seeking for mental health issues than young women [5], due in part to lower levels of openness to acknowledging psychological problems [6].”
From Silence is deadly: a cluster-randomised controlled trial of a mental health help-seeking intervention for young men (2017) · cites this paper as [6]
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“…considerable amount of studies indicated that excessive celebrity worship is associated with body-shape dissatisfaction (e.g., Maltby et al., 2005; Maltby and Day, 2011; Scharf and Levy, 2015), eating disorders (Aruguete et al., 2014; Scharf and Levy, 2015), positive attitudes toward cosmetic…”
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Depression Treatment Patterns among Elderly with Cancer
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“We suggest that the limited use of psychotherapy may be attributed to several factors, including help-seeking behavior among the elderly [18], racial or ethnic disparities in health care [19, 20], restricted access to specialty mental health providers [21], low cultural acceptance of psychotherapy as a treatment [22],…”
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“The current mental health treatment service faces a gap where people who need help do not receive it due to negative perceptions of mental health treatment, lack of professional manpower and physical accessibility limitations [8,9,10].”
BackgroundStigma and Mental Health Service Utilization in Military Personnel: A Review of the Literature
Μιχαλοπούλου, Λ. Ε., Welsh, J. A., Perkins, D. F., & Ormsby, L. (2016) · Military Behavioral Health · doi:10.1080/21635781.2016.1200504 · Cited by 35
“Civilian literature has also indicated that although older adults may hold negative help-seeking attitudes, these attitudes do not appear to be a barrier to seeking help (MacKenzie et al., 2006).”
BackgroundTran, L. D., & Ponce, N. A. (2017) · Californian Journal of Health Promotion · doi:10.32398/cjhp.v15i1.1887 · Cited by 31
“Similarly, men may less readily recognize that they have mental health need than women (Kessler, Brown, & Broman, 1981; Mackenzie et al., 2006).”
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“Women are more likely to have professional help-seeking attitudes [43, 44, 45].”
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“…and share their personal emotional experiences with others (Amin et al., 2018; Kagesten et al., 2016; Rivera, 2020); thus, it is unsurprising that women are more likely to seek support from others for physical and mental distress compared to men (Mackenzie et al., 2006; Morganson et al., 2010).”
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“…treat-ment in men, is also reflected in the wider literature around help-seeking behaviours, in which men were found to hold more negative attitude towards the utilisation of mental health services when compared to women (Addis and Mahalik, 2003; Mackenzie et al ., 2006; Yousaf and Popat, 2015).”
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“, increasing external validity), the scientific community has identified a rising need to translate research into practice [19] and to improve help-seeking attitudes and willingness to seekmental health services through education [20].”
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“The group of beliefs then gives rise to attitudes (positive or negative), and the final part of the process is the execution of actions to receive care (Mackenzie et al., 2006).”
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“…and help-seeking attitudes are less of a barrier for older than younger adults (Andrade et al., 2015; Mackenzie, Del Rosario, & Krook, in press; Mackenzie, Gekoski, & Knox, 2006; Mackenzie, Heath, Vogel, & Chekay, 2019), and in a study of 3,142 older Europeans, stigma was rarely endorsed as a…”
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“This definition was chosen as older adults often have regular contact with primary health care services, and have reported a preference for seeking help for mental health concerns from primary health care providers over mental health professionals (Chai et al., 2021; Mackenzie et al., 2006).”
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“These patterns are consistent with research indicating robust gender differences in help-seeking tendencies in general (Biddle, Gunnell, Sharp, & Donovan, 2004; Blazina & Marks, 2001; Blazina & Watkins, 1996; Deane, Wilson, & Ciarrochi, 2001; Mackenzie et al., 2006), but they contradict the aforementioned logic about…”
BackgroundResultCounseling Attitudes and Stigma Among Polynesian Americans
Allen, G. E. K., Kim, B. S. K., Smith, T. B., & Hafoka, O. (2015) · The Counseling Psychologist · doi:10.1177/0011000015618762 · Cited by 30
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“…never-married adults held more positive attitudes toward seeking help for psychological distress than married adults, it is possible that without the support of a spouse, never-married adults have had to seek professional help in the past, due to lack of informal support (Mackenzie et al., 2006).”
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Harris, J. R. A., Wahesh, E., Barrow, M., & Fripp, J. A. (2021) · Counseling and Values · doi:10.1002/cvj.12145 · Cited by 36
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Lower rates of comorbidities in euthymic bipolar patients
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“According to literature, consultation rates and helpseeking patterns for women are consistently higher than those for men, especially in the case of emotional problems and depressive symptoms (Mackenzie et al. 2006; Judd et al. 2008).”
BackgroundPrevalence and Characteristics of Outpatient Psychotherapy Use
da Silva, P. F. R., & Blay, S. L. (2010) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181f97e1f · Cited by 23
“Studies have shown that, among individuals with psychological problems or diagnosed psychiatric disorders, women seek and receive more help than men (MacKenzie et al., 2006; Judd et al., 2008; Grella et al., 2009), whereas groups such as those formed by the elderly, ethnic minorities, low-income individuals, those wit…”
BackgroundAt-risk youths' self-sufficiency: The role of social capital and help-seeking orientation
Schenk, L., Sentse, M., Lenkens, M., Engbersen, G., van de Mheen, D., Nagelhout, G. E., & Severiens, S. E. (2018) · Children and Youth Services Review · doi:10.1016/j.childyouth.2018.06.015 · Cited by 23
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“This has been noted, for example, in the case of mental health service seeking (Green and Pope 1999; Mackenzie et al. 2006 ).”
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“Age and gender were controlled for in this multiple regression due to research suggesting that these factors can also impact help-seeking and stigma (e.g., Mackenzie et al., 2006; Topkaya, 2014).”
Attitudes Towards (Psychotherapy) Groups: Results of a Survey in a Representative Sample
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#Selfharm on #Instagram: Examining User Awareness and Use of Instagram’s Self-harm Reporting Tool
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“This is not surprising in light of past research finding the variables of attitudes, social norms, and behavioral control to be independently important to mental health-related behaviors (Egbert et al., 2014; Mackenzie et al., 2006; Silk et al., 2017).”
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Binet, É., Ouellet, M., Lebel, J., Békés, V., Morin, C. M., Bergeron, N., Campbell, T. S., Ghosh, S., Bouchard, S., Guay, S., et al. (2021) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-021-01114-w · Cited by 25
Bretherton, S. J. (2021) · The International Journal of Aging and Human Development · doi:10.1177/00914150211050882 · Cited by 29
“Mackenzie, Gekoski and Knox (Mackenzie et al., 2006) also found that the help-seeking propensity subscale on the Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) significantly predicted help-seeking intentions in a sample of Canadian adults.”
BackgroundMethodResultAspects of online college science courses that alleviate and exacerbate undergraduate depression
Busch, C. A., Mohammed, T. F., Nadile, E. M., & Cooper, K. M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269201 · Cited by 22
Aziz, M., Erbad, A., Almourad, M. B., Altuwairiqi, M., McAlaney, J., & Ali, R. (2022) · Life · doi:10.3390/life12081266 · Cited by 22
“[16] studied the differences in helpseeking outlooks amongst the different age and gender groups using a sample size of 206 participants.”
BackgroundMethodInfluentialAttitude and Impact of Perceived Depression in the Workplace
Wang, Y., & Gorenstein, C. (2014) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph110606021 · Cited by 24
“In addition to gender-determined psychopathological difference when depressed [38], men show less favorable help-seeking attitudes concerning their health needs [48,49].”
BackgroundLeisure, Relatedness, and Ill-Being among Older Adults in Long-Term Care
Duncan, J. M., Killian, T. S., & Lucier‐Greer, M. (2017) · Activities Adaptation & Aging · doi:10.1080/01924788.2017.1326764 · Cited by 22
Campbell, A., Ridout, B., Amon, K. L., Navarro, P., Collyer, B., & Dalgleish, J. (2019) · Journal of Medical Internet Research · doi:10.2196/16176 · Cited by 22
“The potential significance of the proposed research is the provision of greater access to online support for clients of Kids Helpline and other online mental health services globally; lack of access is highly problematic, given that young people often do not know how to access mental health services as first-time user…”
BackgroundAgyemang‐Duah, W., Peprah, C., & Arthur-Holmes, F. (2019) · Gerontology and Geriatric Medicine · doi:10.1177/2333721419855455 · Cited by 21
Social Media Use as Self-Therapy or Alternative Mental Help-Seeking Behavior
Gere, B., Salimi, N., & Anima-Korang, A. (2020) · IAFOR Journal of Psychology & the Behavioral Sciences · doi:10.22492/ijpbs.5.2.02 · Cited by 26
Reynolds, K., Mackenzie, C. S., Medved, M. I., Dudok, S., & Koven, L. (2022) · Ageing and Society · doi:10.1017/s0144686x21001896 · Cited by 24
“Attitudes are important predictors of treatment-seeking preferences (Cramer, 1999; Mackenzie et al ., 2006, 2008; ten Have et al ., 2010).”
BackgroundSelf-citationGitlin, L. N., Chernett, N. L., Dennis, M. P., & Hauck, W. W. (2012) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31825463ce · Cited by 21
Sex differences in attitudes towards females with eating disorders
Makowski, A. C., Mnich, E. E., Angermeyer, M. C., Löwe, B., & Knesebeck, O. V. D. (2014) · Eating Behaviors · doi:10.1016/j.eatbeh.2014.10.017 · Cited by 21
Male views on help‐seeking for depression: A Q methodology study
House, J., Marasli, P., Lister, M., & Brown, J. S. L. (2017) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12144 · Cited by 21
Sukontapol, C., Kemsen, S., Chansirikarn, S., Nakawiro, D., Kuha, O., & Taemeeyapradit, U. (2018) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2018.04.028 · Cited by 22
Adams, L., Koop, P.-H., Quan, H., & Norris, C. M. (2014) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12169 · Cited by 21
Park, S., Jeon, M., Lee, Y., Ko, Y.-M., & Kim, C. E. (2018) · International Journal of Social Psychiatry · doi:10.1177/0020764018760952 · Cited by 20
Engaging in Late-Life Mental Health Research: a Narrative Review of Challenges to Participation
Newmark, J., Gebara, M. A., Aizenstein, H. J., & Karp, J. F. (2020) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-020-00217-9 · Cited by 21
Robinson, L. E., Espelage, D. L., Valido, A., Ingram, K. M., Sheikh, A. J. E., Torgal, C., Mintz, S., & Kuehl, T. (2021) · School Mental Health · doi:10.1007/s12310-021-09419-9 · Cited by 26
Onsy, E., & Amer, M. M. (2014) · Procedia - Social and Behavioral Sciences · doi:10.1016/j.sbspro.2014.04.455 · Cited by 20
Madianos, M. G., Zartaloudi, A., Alevizopoulos, G., & Katostaras, T. (2011) · Community Mental Health Journal · doi:10.1007/s10597-011-9404-y · Cited by 18
“Several investigators reported an association between higher education and more liberal views about the treatment of persons suffering from mental illness or a higher level of readiness to ask for help in case of a mental health problem (Kelly and Achter 1995; Mackenzie et al. 2007 ).”
BackgroundTurner, E. A., & Mohan, S. (2015) · Community Mental Health Journal · doi:10.1007/s10597-015-9976-z · Cited by 20
“To date, research has consistently shown that females report higher intentions to seek services, more positive attitudes, and less stigma toward service use than males (e.g., Mackenzie et al. 2006; Smith et al. 2004).”
BackgroundRastogi, R., Woolverton, G. A., Stevens, C., Chen, J. A., & Liu, C. H. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.115825 · Cited by 20
Prisoners at ultra-high-risk for psychosis: a cross-sectional study
Jarrett, M., Valmaggia, L., Parrott, J. M., Forrester, A., Winton‐Brown, T., Maguire, H., Ndegwa, D., McGuire, P. K., & Craig, T. (2015) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796015000062 · Cited by 19
“However, there are various consistent factors that are influential in whether and when individuals seek help for mental health (MH) problems (e.g., male gender, McKenzie et al. 2006; younger age, McKenzie et al. 2006; Black ethnicity, Morgan et al. 2005).”
Machlin, A., King, K., Spittal, M. J., & Pirkis, J. (2017) · International Journal of Mental Health Promotion · doi:10.1080/14623730.2017.1307774 · Cited by 19
Yom‐Tov, E., Lekkas, D., Heinz, M. V., Nguyen, T., Barr, P. J., & Jacobson, N. C. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.11.024 · Cited by 18
“This is consistent with evidence that depression and anxiety are more common in women than men (Eaton et al., 2012) and broadly speaks to more prominent mental health-related help-seeking behaviors in women (Mackenzie et al., 2006).”
BackgroundRens, E., Portzky, G., Morrens, M., Dom, G., den Broeck, K. V., & Gijzen, M. (2023) · BMC Public Health · doi:10.1186/s12889-023-16630-7 · Cited by 19
“In general, men are less likely to perceive a need for mental health care and have less favorable attitudes towards psychological openness and help-seeking for mental health problems [43].”
BackgroundGuihan, M., Sohn, M., Bauman, W. A., et al. (2016) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2016.05.025 · Cited by 19
Attitudinal Differences towards Mental Health Services between Younger and Older New Zealand Adults
James, S. A., & Buttle, H. (2008) · New Zealand journal of psychology · Cited by 19
Boonstra, A., van Mastrigt, G. A. P. G., Evers, S. M. A. A., van Amelsvoort, T. A. M. J., Leijdesdorff, S. M. J., & @ease consortium (2023) · Early Intervention in Psychiatry · doi:10.1111/eip.13443 · Cited by 18
Factors Influencing on Mental Health Help-seeking Behavior Among Korean Women: A Path Analysis
Arnault, D. S., Gang, M., & Woo, S. (2017) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2017.10.003 · Cited by 18
Samuel, R., & Kamenetsky, S. B. (2022) · Canadian Journal of Higher Education · doi:10.47678/cjhe.v52i1.189245 · Cited by 28
“Canadian Journal of Higher Education | Revue canadienne d’enseignement supérieur 52:1 (2022) 43 vious research (Chandra & Minkovitz, 2006; Jagdeo et al., 2009; Mackenzie et al., 2006), gender and SES were not significantly associated with attitudes toward seeking mental health services.”
BackgroundZapata, A., Beaudreau, S., O'Hara, R., Merrell, S. B., Bruce, J. S., Garrison-Diehn, C., & Gould, C. (2017) · Clinical Gerontologist · doi:10.1080/07317115.2017.1359716 · Cited by 20
“Consistent with previous studies, health care professionals were the most reported resource for information among our participants (e.g., Mackenzie et al., 2006).”
BackgroundResultChoi, S., Ramos, C., Kim, K., & Azim, S. F. (2019) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-019-00583-y · Cited by 16
Metadata
- Authors
- Mackenzie, C. S., Gekoski, W. L., & Knox, V. J.
- Affiliations
- Queen's University (CA)
- Corresponding author
- Mackenzie, C. S.
- ORCID
- Mackenzie, C. S.
- Venue
- Aging & Mental Health
- Publisher
- Informa UK Limited
- Published
- 2006-11
- Volume
- 10
- Issue
- 6
- Pages
- 574-582
- ISSN
- 1360-7863 (ISSN-L)
- 1364-6915
- OpenAlex
- W2014172961
- Semantic Scholar
- d232506e2297dea5f6d1729b555e7bd93577103f
- Cited by
- 878
- References
- 42
- Citations by year
- 2026: 48 · 2025: 51 · 2024: 75 · 2023: 79 · 2022: 71 · 2021: 63 · 2020: 60 · 2019: 69 · 2018: 51 · 2017: 48 · 2016: 40 · 2015: 48 · 2014: 40 · 2013: 36 · 2012: 29
- FWCI
- 13.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Aging & Mental Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Gender Studies › Gender Roles and Identity Studies
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- help-seeking attitudes, mental health service utilization, underutilization of mental health services, age differences, gender differences, older adults, men, help-seeking intentions, open-mindedness, primary care mental health, psychiatric symptoms, help-seeking barriers
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Mental Disorders, Demography, Educational Status, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Mental Health Services, Middle Aged, Ontario, Patient Acceptance of Health Care, Personality Inventory, Surveys and Questionnaires, Regression Analysis, Sex Factors, Marital Status
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