Department of Psychiatry,University Medicine Greifswald,Ellernholzstraße 2, Greifswald,Germany.
Department Health and Prevention,University Greifswald,Robert-Blum-Straße 13, Greifswald,Germany.
Epidemiol Psychiatr Sci. 2019 Aug;28(4):446-457. doi: 10.1017/S2045796017000828. Epub 2018 Jan 16.
Many people with mental illness do not seek professional help. Beliefs about the causes of their current health problem seem relevant for initiating treatment. Our aim was to find out to what extent the perceived causes of current untreated mental health problems determine whether a person considers herself/himself as having a mental illness, perceives need for professional help and plans to seek help in the near future.
In a cross-sectional study, we examined 207 untreated persons with a depressive syndrome, all fulfilling criteria for a current mental illness as confirmed with a structured diagnostic interview (Mini International Neuropsychiatric Interview). The sample was recruited in the community using adverts, flyers and social media. We elicited causal explanations for the present problem, depression literacy, self-identification as having a mental illness, perceived need for professional help, help-seeking intentions, severity of depressive symptoms (Patient Health Questionnaire - Depression), and whether respondents had previously sought mental healthcare.
Most participants fulfilled diagnostic criteria for a mood disorder (n = 181, 87.4%) and/or neurotic, stress-related and somatoform disorders (n = 120, 58.0%) according to the ICD-10. N = 94 (45.4%) participants had never received mental health treatment previously. Exploratory factor analysis of a list of 25 different causal explanations resulted in five factors: biomedical causes, person-related causes, childhood trauma, current stress and unhealthy behaviour. Attributing the present problem to biomedical causes, person-related causes, childhood trauma and stress were all associated with stronger self-identification as having a mental illness. In persons who had never received mental health treatment previously, attribution to biomedical causes was related to greater perceived need and stronger help-seeking intentions. In those with treatment experience, lower attribution to person-related causes and stress were related to greater perceived need for professional help.
While several causal explanations are associated with self-identification as having a mental illness, only biomedical attributions seem to be related to increase perceived need and help-seeking intentions, especially in individuals with no treatment experiences. Longitudinal studies investigating causal beliefs and help-seeking are needed to find out how causal attributions guide help-seeking behaviour. From this study it seems possible that portraying professional mental health treatment as not being restricted to biomedical problems would contribute to closing the treatment gap for mental disorders.
许多患有精神疾病的人并不寻求专业帮助。他们对当前健康问题原因的看法似乎与治疗的启动有关。我们的目的是了解当前未得到治疗的精神健康问题的感知原因在多大程度上决定一个人是否认为自己患有精神疾病，是否认为需要专业帮助，并计划在不久的将来寻求帮助。
在一项横断面研究中，我们检查了 207 名患有抑郁综合征的未经治疗的患者，所有患者均符合当前精神疾病的标准，这些标准均通过结构诊断访谈（迷你国际神经精神访谈）得到确认。该样本是通过广告、传单和社交媒体在社区中招募的。我们引出了当前问题、抑郁知识、自我认同为患有精神疾病、对专业帮助的需求、寻求帮助的意愿、抑郁症状严重程度（患者健康问卷-抑郁）的原因，并询问受访者是否之前曾寻求过精神保健。
大多数参与者根据 ICD-10 标准符合心境障碍（n=181，87.4%）和/或神经症、应激相关和躯体形式障碍的诊断标准（n=120，58.0%）。n=94（45.4%）名参与者之前从未接受过精神健康治疗。对 25 种不同原因的解释列表进行探索性因素分析，结果得出五个因素：生物医学原因、个体相关原因、儿童创伤、当前压力和不健康行为。将当前问题归因于生物医学原因、个体相关原因、儿童创伤和压力均与更强的自我认同为患有精神疾病相关。在从未接受过精神健康治疗的患者中，将问题归因于生物医学原因与更强的需求和寻求帮助的意愿相关。在有治疗经验的患者中，较低的归因于个体相关原因和压力与对专业帮助的更大需求相关。
虽然有几个原因与自我认同为患有精神疾病有关，但只有生物医学归因似乎与增加需求和寻求帮助的意愿有关，尤其是在没有治疗经验的个体中。需要进行纵向研究来调查因果信念和寻求帮助，以了解因果归因如何指导寻求帮助的行为。从这项研究中可以看出，将专业的心理健康治疗描绘为不仅限于生物医学问题可能有助于缩小精神障碍治疗差距。
