Addressing psychosocial barriers to engaging in mental health care services for women across the lifespan

Mental illness stigma is high, and mental health service utilization is low, among underserved communities in the U.S., in particular, among Black adults. Stigma is characterized by negative attitudes or beliefs about mental illness, or negative behaviors directed toward people with mental illness (PWMI), and may be held by PWMI or the general public. Stigma compounds disabilities related to the primary symptoms of mental illness, inhibits mental health care seeking behavior, and increases morbidity and premature mortality related to mental illness. In addition, medical mistrust (defined as a belief that an entity is working against one’s best interest or wellbeing) may be directed towards individuals (health professionals) or health systems (hospitals or clinics), and is a known psychosocial barrier to engagement in mental health services in underserved communities. There are gendered differences in the approach to understanding symptoms of illness, prevalence and incidence of disease, and willingness to engage in mental health services. Understanding the psychosocial barriers that prevent early engagement in mental health service care is critical to improving mental health outcomes for underserved populations. Having health professionals of shared sociodemographic characteristics such as racial/ethnic/gender/religious background may enhance communication and trust, and may reduce hesitancy towards accessing health services. Designing interventions that can reduce stigma, address medical mistrust, and increase early engagement for underserved populations would likely contribute to reducing ongoing health disparities. Understanding the unique needs of underserved women is vital towards closing mental illness disparity gaps.

Black adults delay treatment seeking and use mental health services at significantly lower rates than white adults, often resulting in more severe and chronic mental illness. Understanding the complex relationship between mental health knowledge, stigma, and service utilization is critical. This study examines how general and specific mental health knowledge are associated with willingness to engage in help-seeking behaviors and the moderating role of stigma. A cross-sectional survey of Black adults across the United States (N = 1,117) assessed mental health knowledge, health service utilization, and the effects of mental illness stigma using tailored instruments. Gender differences emerged, with black females showing significantly higher specific mental health knowledge of depression, bipolar disorder, and drug addiction, while Black males had greater knowledge about stress (ps< .01). Gamma regression analyses revealed that participants with greater mental health knowledge about depression, schizophrenia, bipolar disorder, and drug addiction were more likely to report willingness to seek help from a mental health professional for personal/emotional problems and suicidal thoughts, controlling for demographic factors. Furthermore, future intended stigma behavior significantly moderated the association between specific knowledge (i.e., depression, bipolar disorder) and help seeking behavior (RRs: 0.94 to 0.97, ps< .05). Culturally tailored education programs and community-based outreach initiatives should aim to tailor programs that acknowledge potential gender differences in approach and knowledge of mental illness and treatment.

Field testing of interventions for psychoeducation programs needs to consider personalized needs of participants based on socio-demographic factors. The use of interventions to improve mental health require understanding the specific needs of underserved communities. Black adults benefit from ensuring a user centered design approach to the development of psychoeducational programs. We conducted a field testing study to understand the unique needs of Black adults with moderate and severe depression or anxiety. Our goal was to build a final intervention that used narrative storytelling to enhance knowledge, promote positive attitudes and prompt help-seeking behavior for Black adults living with depression or anxiety who were not seeking routine mental health care.