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Mental Health Treatment Seeking Among Older Adults With Depression: The Impact of Stigma and Race
Open accessAbstract
Objective Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need services from seeking care. This study examined the impact of public stigma (negative attitudes held by the public) and internalized stigma (negative attitudes held by stigmatized individuals about themselves) on racial differences in treatment-seeking attitudes and behaviors among older adults with depression.Method Random digit dialing was utilized to identify a representative sample of 248 African American and white older adults (older than 60 years) with depression (symptoms assessed by the Patient Health Questionnaire-9). Telephone-based surveys were conducted to assess their treatment-seeking attitudes and behaviors and the factors that impacted these behaviors.Results Depressed older adult participants endorsed a high level of public stigma and were not likely to be currently engaged in or did they intend to seek mental health treatment. Results also suggested that African American older adults were more likely to internalize stigma and endorsed less positive attitudes toward seeking mental health treatment than their white counterparts. Multiple regression analysis indicated that internalized stigma partially mediated the relationship between race and attitudes toward treatment.Conclusion Stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression, particularly African American elders. Interventions to target internalized stigma are needed to help engage this population in psychosocial mental health treatments.
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“Perceived stigma has been demonstrated to be related to willingness to receive mental health services among members of traditionally underserved populations such as African Americans and older adults (Conner et al., 2010).”
From Using Mindfulness- and Acceptance-Based Treatments With Clients From Nondominant Cultural and/or Marginalized Backgrounds: Clinical Considerations, Meta-Analysis Findings, and Introduction to the Special Series (2013) · cites this paper as Conner et al., 2010
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BackgroundStigma, race, and disease in 20th century America
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McGee, J. W., & Becker, H. S. (1957) · The American Catholic Sociological Review · doi:10.2307/3709145 · Cited by 68 · cited 1×
“Historically, stigma theorists using the social cognitive approach focused on understanding the stigmatization of social deviants such as thieves, the physically disabled, adulterers, and traitors (Akerstrom, 1986; Becker, 1956) and subsequently the stigmatization of racial and ethnic minorities (Steele & Aronson, 199…”
BackgroundThe effect of patient and visit characteristics on diagnosis of depression in primary care.
Harman, J. S., Schulberg, H. C., Mulsant, B. H., & Reynolds, C. F. (2001) · PubMed · Cited by 68
Self-citationPingitore, D. P., Snowden, L. R., Sansone, R. A., & Klinkman, M. S. (2001) · The International Journal of Psychiatry in Medicine · doi:10.2190/6bul-mwtq-0m18-30gl · Cited by 67
Mental Health Service Use among Older African Americans: The National Survey of American Life
Neighbors, H. W., Woodward, A. T., Bullard, K., Ford, B. C., Taylor, R., & Jackson, J. (2008) · The American journal of geriatric psychiatry · doi:10.1097/jgp.0b013e318187ddd3 · Cited by 64
Gum, A. M., Iser, L., & Petkus, A. (2010) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181c29495 · Cited by 64
Attitudes of Hispanic, Black, and Caucasion University Students Toward Mental Illness
Crane, R. S., & Spielberger, C. D. (1981) · Hispanic Journal of Behavioral Sciences · doi:10.1177/073998638100300302 · Cited by 63
Race, Gender and Class: Guidelines for Practice With Individuals, Families and Groups
Davis, L. E., & Proctor, E. K. (1989) · Medical Entomology and Zoology · Cited by 63
Rosenstein, L. D. (1998) · Neuropsychology Review · doi:10.1023/a:1025628925796 · Cited by 63 · cited 1×
“Aging also carries with it an increased risk of degenerative organic disorders such as Alzheimer’s and Parkinson’s and specific mental illnesses such as dementia and depression (Rosenstein, 1998).”
BackgroundSirey, J. A., BRUCE, M. L., & Kales, H. C. (2010) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181cdeb7d · Cited by 62
Neighbors, H. W. (1988) · PubMed · Cited by 61
1/Reasons for Low Utilization of Mental Health Services by the Elderly
Lasoski, M. C. (1986) · Clinical Gerontologist · doi:10.1300/j018v05n01_01 · Cited by 60
Ethnic Minority Elders in the UK
Manthorpe, J., & Hettiaratchy, P. (1993) · International Review of Psychiatry · doi:10.3109/09540269309028308 · Cited by 56
Barriers and Contributors to Minority Older Adults' Access to Mental Health Treatment
Choi, N. G., & Gonzalez, J. M. (2005) · Journal of Gerontological Social Work · doi:10.1300/j083v44n03_08 · Cited by 54 · cited 1×
“African American older adults suffer more psychological distress than their White counterparts due to their life long exposure to and experiences with racism, discrimination, prejudice, poverty, and violence(8); and they tend to have fewer psychological, social, and financial resources for coping with stress than thei…”
Random Digit Dialing: A Sampling Technique for Telephone Surveys
Cummings, K. M. (1979) · Public Opinion Quarterly · doi:10.1086/268514 · Cited by 53 · cited 1×
“Random digit dialing (RDD) is identified as the most statistically valid method of telephone sampling (Cummings, 1979).”
MethodOutcasts in prison: The cases of informers and sex offenders
Åkerström, M. (1986) · Deviant Behavior · doi:10.1080/01639625.1986.9967691 · Cited by 52
Counselor Dissimilarity Confrontation, Client Cultural Mistrust, and Willingness to Self‐Disclose
Poston, W. S. C., Craine, M. H., & Atkinson, D. R. (1991) · Journal of Multicultural Counseling and Development · doi:10.1002/j.2161-1912.1991.tb00623.x · Cited by 51
Impact of screening old people with physical illness for depression?
Katona, C., & Livingston, G. (2000) · The Lancet · doi:10.1016/s0140-6736(00)02466-1 · Cited by 51 · cited 1×
“Katona and Livingston (2000) identify the stigma of mental illness as the most fundamental reason why elderly people choose not to seek mental health services.”
BackgroundMental disorders among elderly people in primary care: the Linköping study
Ólafsdóttir, M., Marcusson, J., & Skoog, I. (2001) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2001.104001012.x · Cited by 50
Attitudes toward Psychotherapists, Psychologists, Psychiatrists, and Psychoanalysts
von Sydow, K., & Reimer, C. (1998) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1998.52.4.463 · Cited by 44
Descriptive profile of the mentorship relationships of Latino adolescents
Sánchez, B., & Reyes, O. (1999) · Journal of Community Psychology · doi:10.1002/(sici)1520-6629(199905)27:3 · Cited by 44
Copeland, V. C. (2006) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-006-0061-x · Cited by 42 · cited 1×
“Identifying specific attitudes and beliefs about depression provides an opportunity to develop clinical and community-based interventions to reduce stigma and increase treatment utilization by those suffering from depression and other mental illnesses (Copeland, 2006).”
BackgroundSelf-citationProviding culturally appropriate mental health services for minorities
Wallen, J. (1992) · The Journal of Behavioral Health Services & Research · doi:10.1007/bf02518993 · Cited by 38 · cited 1×
“Consistent with prior studies however(11,46-48), African Americans were significantly less likely than their White counterparts to have ever sought mental health treatment.”
Mental health services for the elderly: Key policy elements.
Estes, C. L. (1995) · American Psychological Association eBooks · doi:10.1037/10179-012 · Cited by 37 · cited 1×
“4 million older adults in the United States are in need of mental health treatment, yet less than 1 million of them actually receive services (Estes, 1995).”
BackgroundPollio, D. E., North, C. S., & Osborne, V. A. (2002) · Community Mental Health Journal · doi:10.1023/a:1019812512926 · Cited by 34
Effects of Perceived Responsibility on Help-Seeking Decisions Among Elderly Persons
Ray, D. C., Raciti, M. A., & MacLean, W. E. (1992) · Journal of Gerontology · doi:10.1093/geronj/47.3.p199 · Cited by 33
Behavioral health needs and problem recognition by older adults receiving home-based aging services
Gum, A. M., Petkus, A., McDougal, S. J., Present, M., King‐Kallimanis, B., & Schonfeld, L. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2135 · Cited by 32
Ambulatory medical care among adult black Americans: the hospital emergency room.
Neighbors, H. W. (1986) · PubMed · Cited by 28
Age and Mental Health Services
Horwitz, A. V., & Uttaro, T. (1998) · Community Mental Health Journal · doi:10.1023/a:1018717808191 · Cited by 27
Practice with People with Severe Mental Illness: Rewards, Challenges, Burdens
Newhill, C. E., & Korr, W. S. (2004) · Health & Social Work · doi:10.1093/hsw/29.4.297 · Cited by 26
When Do Older Adults Seek Primary Care Services for Depression?
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A Cross-Cultural Study of Attitudes towards Seeking Psychological Help
Furnham, A. F., & Andrew, R. L. (1996) · Psychological Reports · doi:10.2466/pr0.1996.79.1.289 · Cited by 24 · cited 2×
“While this finding is inconsistent with some other studies that have found no racial differences in attitudes about mental health treatment(18-21), the current study has found divergent results for, at least, three reasons.”
Barriers to serving older adults with a psychiatric disability.
Hatfield, A. B. (1999) · Psychiatric Rehabilitation Journal · doi:10.1037/h0095234 · Cited by 23
Gerontology Content in MSW Curricula and Student Attitudes Toward Older Adults
Olson, M. D. (2007) · Educational Gerontology · doi:10.1080/03601270701632230 · Cited by 22 · cited 1×
“The number of geriatric social workers is extremely inadequate (Olson, 2007), and there are few Masters in Social Work programs with a specialization in geriatric mental health.”
BackgroundThe acceptability of a culturally-tailored depression education videotape to African Americans.
Primm, A. B., Cabot, D., Pettis, J., Vu, H. T., & Cooper, L. A. (2002) · PubMed Central · Cited by 21
Improving the Primary Care Treatment of Late Life Depression: Progress and Opportunities
Coyne, J., & Katz, I. R. (2001) · Medical Care · doi:10.1097/00005650-200108000-00002 · Cited by 19
Enhancing the Cultural Relevance of Empirically-Supported Mental Health Interventions
Conner, K. O., & Grote, N. K. (2008) · Families in Society The Journal of Contemporary Social Services · doi:10.1606/1044-3894.3821 · Cited by 17
Self-citationAsbury, C. A., Walker, S., Belgrave, F. Z., Maholmes, V., & Green, L. E. (1994) · Rehabilitation Psychology · doi:10.1037/h0080314 · Cited by 14
A Scottish survey of attitudes to depression in older and younger adults
DAVIDSON, K., & Connery, H. (2003) · Journal of Mental Health · doi:10.1080/09638230310001603564 · Cited by 13
Maintenance Treatment of Depression in Old Age
Bajbouj, M., & Danker‐Hopfe, H. (2006) · New England Journal of Medicine · doi:10.1056/nejmc061020 · Cited by 13 · cited 1×
“With the numbers of older adults rapidly increasing in the United States, untreated mental illness among older adults is one of the most significant challenges facing the mental health service delivery system (President’s New Freedom Commission on Mental Health, 2003), especially considering that the combination of ps…”
Background
Research works printed but not linked: 1
- Brown, 2004, Treatment of depression in African American primary care patients, Afr Am Res Perspect, 10, 55
Cited by
Sorted by citations
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S. L., & Thornicroft, G. (2015) · Psychological Medicine · doi:10.1017/s0033291714000129 · Cited by 3,152
The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014) · Psychological Science in the Public Interest · doi:10.1177/1529100614531398 · Cited by 1,642
“, 2013; Pederson & Vogel, 2007) and ethnicity (Cheng, Kwan, & Sevig, 2013; Conner et al., 2010).”
Liu, C. H., Stevens, C., Wong, S. H. M., Yasui, M., & Chen, J. A. (2019) · Depression and Anxiety · doi:10.1002/da.22830 · Cited by 603
“This too could be due to underreporting, with views held among Blacks that mental illness is a weakness that should not be disclosed (Conner et al., 2010), and the possibility that the language and framing of the instruments for detecting symptoms may not be sensitive for use among Blacks (Ellis, 2003).”
Artificially intelligent chatbots in digital mental health interventions: a review
Boucher, E. M., Harake, N. R., Ward, H. E., Stoeckl, S. E., Vargas, J., Minkel, J., Parks, A. C., & Zilca, R. (2021) · Expert Review of Medical Devices · doi:10.1080/17434440.2021.2013200 · Cited by 440
“While some individuals do not seek treatment because of low perceived need [6] or attitudinal barriers like perceived stigma [7],”
BackgroundHearing Loss and Depression in Older Adults: A Systematic Review and Meta-analysis
Lawrence, B. J., Jayakody, D. M. P., Bennett, R. J., Eikelboom, R. H., Gasson, N., & Friedland, P. L. (2019) · The Gerontologist · doi:10.1093/geront/gnz009 · Cited by 440
Metadata
- Authors
- Conner, K. O., Copeland, V. C., Grote, N. K., Koeske, G., Rosen, D., Reynolds, C. F., & Brown, C.
- Affiliations
- University of Pittsburgh (US)
- University of Washington (US)
- Corresponding author
- Conner, Kyaien O.
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 18
- Issue
- 6
- Pages
- 531-543
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC2875324
- OpenAlex
- W1990523273
- Cited by
- 568
- References
- 133
- Citations by year
- 2026: 25 · 2025: 34 · 2024: 39 · 2023: 54 · 2022: 37 · 2021: 52 · 2020: 37 · 2019: 45 · 2018: 40 · 2017: 40 · 2016: 24 · 2015: 40 · 2014: 34 · 2013: 28 · 2012: 16
- FWCI
- 27.85
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- D-Scholarship@Pitt (University of Pittsburgh) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K23MH067595, P30-MH 71944, P30MH071944, K23MH090151)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Social Sciences › Gender Studies › Gender Roles and Identity Studies
- Keywords
- mental health treatment seeking, depression, older adults, public stigma, self-stigma, racial differences, African American older adults, help-seeking attitudes, help-seeking intentions, mental health stigma
- MeSH terms
- Aged, Aged, 80 and over, Attitude to Health, Black or African American, Depression, Female, Humans, Male, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Stereotyping, White People
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