According to the World Health Organisation an estimated 200 million people globally are affected by serious mental health problems, however, research evidence indicates that only around one-third of those experiencing mental health difficulties actually seek treatment. A number of psycho-social and demographic factors have been found to explain variation in attitudes towards, and intentions to, seek psychological help. This study sought to examine the association between attitudes towards seeking mental health services and intentions to engage in psychological counselling. The sample for the current study consisted of 331 active and retired members of the national police force of the Republic of Ireland. It was predicted that psychological openness, help-seeking propensity, and indifference to stigma would all positively predict intentions to participate in psychological counselling, after controlling for age, gender and personality factors.
The results showed that Finish Abstract
According to the World Health Organisation an estimated 200 million people globally are affected by serious mental health problems (Mollica, 2000). Available data, however, suggests that only around one-third of those experiencing mental health difficulties actually make treatment contact (Kessler et al., 2009). This is of concern not only because of the deleterious impact on individual’s lives, but also because of the associated economic and societal costs of untreated mental health problems (Kessler et al., 2009). A number of psycho-social and demographic factors have been found to explain variation in attitudes towards, and intentions to, seek psychological help (e.g., Bartels, 2003; Segal, Coolidge, Mincic, & O’Riley, 2005; Vogel, Wester, Wei, & Boysen, 2005). How favourable and effective one believes psychological counselling to be, one’s own belief in their capacity to engage in counselling, and perceptions of subsequent social rejection following counselling attendance, have been identified as particularly influential (e.g., Hyland, McLaughlin, Boduszek, & Prentice, 2012; Vogel & Wester, 2003).
Research also suggests that females may be significantly more likely than males to hold favourable attitudes towards utilising mental health services (e.g., Chandra & Minkovitz 2006; Raunic & Xenos, 2008), although some studies have shown that males and females do not differ in their attitudes or intentions towards the utilisation of mental health services (e.g., Kelly & Achter, 1995; Vogel & Wester, 2003). Additionally, personality factors have been suggested to impact upon individuals’ help-seeking attitudes and intentions. Jagdeo, Cox, Stein, and Sareen (2009) found that antisocial personality disorder was associated with greater negative attitudes towards help-seeking using data from the US National Comorbidity Survey (NCS) (n = 5877) and the Ontario Health Survey (OHS) (n = 6902). Given the disparity between mental health service needs and service utilization a more comprehensive understanding of the factors involved in counselling-seeking behaviour is required.
The Inventory of Attitudes toward Seeking Mental Health Services (IASMHS; Mackenzie, Knox, Gekoski, & Macaulay, 2004) is a 24-item scale designed to assess the attitudinal factors that influence the seeking of mental health services. This scale was developed based upon Fisher and Turner’s (1970) Attitudes toward Seeking Professional Psychological Help Scale. The scale was developed with a clear theoretical foundation, and its increasing use in research (James & Buttle, 2008; Loya, Reddy, & Hinshaw, 2010; Mackenzie, Gekoski, & Knox, 2006; Mojaverian, Hashimoto, & Kim, 2012; Floersch et al., 2009). The IASMHS initially included 41-items, however the results an exploratory factor analysis (EFA) using maximum likelihood estimation among a sample of 208 adult volunteers (Mackenzie et al., 2004) reduced the number of items in the scale to 24.
Results indicated that the 24-item scale could be explained in terms of three correlated factors, which accounted for 43% of variance: (a) Psychological Openness (the degree to which an individual is open to acknowledging the presence of a psychological problem and to seek professional care for such a problem), (b) Help-Seeking Propensity (one’s willingness and perceived ability to seek help for psychological problems), and (c) Indifference to Stigma (how concerned an individual would feel were significant others to discover that they were receiving psychological care). Internal consistency coefficients for the IASMHS subscales were reported to be good with Cronbach’s alphas of .82 (psychological openness), .76 (help-seeking propensity), and .79 (indifference to stigma).
Factor correlations were moderate with r values ranging from .37 to .47. In the same paper, using an independent sample of 293 undergraduate university students and employing confirmatory factor analysis (CFA) techniques, Mackenzie and colleagues (2004) reported that they replicated the three-factor solution indicated by the EFA. Model fit was acceptable and factor correlations ranged from r = .26 to .43. The current study aims to assess the degree to which intentions to participate in psychological counselling can be predicted by attitudes towards seeking mental health services. Specifically, it was predicted that psychological openness, help-seeking propensity, and indifference to stigma would all positively predict intentions to participate in psychological counselling, after controlling for age, gender and personality factors.
The sample for the current study consisted of 331 (Males: n = 202; Females: n = 129) active and retired members of the national police force of the Republic of Ireland. Of the officers recruited, 302 (91%) were currently serving members of the Irish police force, while 29 (9%) were retired. Participants ranged in age from 20 to 77 years, with an average age of 28.41 years (SD = 8.63). Just under half the sample of officers were stationed in rural areas (45%, n = 149), 41% were stationed in suburban areas (n = 136), and 14% were stationed in urban areas (n = 46). The majority of officers who participated in this study were recent entrants into the police service with 63% of respondents indicating that they had been serving for two years or less (n = 209). Approximately half were married (48%, n = 159), while the remaining participants either resided with parents (27%, n = 89), lived with other family members (3%, n = 10), or lived alone (22%, n = 73).
The majority of study participants were recruited during a training seminar (n = 259), while the remaining officers were recruited via formal written requests (n = 72). Appropriate authorization was granted from the relevant officials to carry out the study. In total, 532 members were approached to complete the research questionnaire, and 365 volunteered their participation (68%). However due to overwhelming missing data in 34 returned surveys only 331 responses were retained for the final analysis (62%).
Participants were required to complete an anonymous self-report, paper-and-pencil questionnaire booklet which included an instruction sheet and a consent form attached to the front of the booklet. Participants were assured about confidentiality and informed that their participation was voluntary. Completed questionnaires were returned by the participants to their superior officer in sealed envelopes, and were subsequently returned to the principal investigator.
The Inventory of Attitudes toward Seeking Mental Health Services (IASMHS: Mackenzie et al., 2004) is a 24-item scale designed to measure an individual’s attitudes towards seeking mental health services. The IASMHS was developed in order to measure three factors labeled (a) Psychological openness, (b) Help-seeking propensity, and (c) Indifference to stigma. Psychological openness reflects the degree to which an individual is open to acknowledging the presence of a psychological problem and to seek professional care for such a problem. Help-seeking propensity reflects one’s willingness and perceived ability to seek help for psychological problems. Indifference to stigma refers to how concerned an individual would feel if significant others were to discover that they were receiving psychological care. Each factor is proposed to be measured via 8 items and each item is measured using a five point Likert-scale ranging from 0 (“disagree”) to 4 (“agree”).
Intentions to Participate in Psychological Counselling: Intentions were measured as part of a larger questionnaire designed to measure the various constructs of the Theory of Planned Behavior (Ajzen, 1991). This questionnaire was constructed according to the guidelines set forth by Ajzen (1991, 2002). The questionnaire was based upon a fictitious scenario which included the four elements of time, context, action, and target, as proposed by Ajzen and Fishbein (1977). The scenario describes an event that took place six weeks previously in which an individual witnesses a severe road traffic accident. In the intervening six weeks this individual begins to experience significant personality changes.
The individual is reported to now experience prolonged periods of extreme sadness, lack of energy, distressing thoughts related to the traumatic event, reduced interest in normally pleasurable activities, severe panic attacks while outside, and refusal to leave the house even for work. A friend of this individual attends a G.P. about the matter and the G.P. recommends that the described person should attend a professional psychologist for counselling within the next week. An appointment is thus made for next week. Participants in this study are asked to place themselves in the position of this fictitious person and to complete the questions that follow (see Appendix A for the full vignette).
Behavioural intentions were measured via three items (Cronbach’s alpha = .77). 1. How likely is it that you would intend to go along to see a professional psychologist for counseling within the next week if you were in Terry’s position? 2. You will try to participate in counseling with a professional psychologist within the next week. 3. You have decided to participate in counseling with a professional psychologist within the next week. Each item was measured along a seven point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely) and the scores on the three questions were summed. Higher scores on this scale indicate stronger intentions to engage in counselling.