Since 1990 several population studies, mostly performed in Germany and the United Kingdom, have investigated beliefs about mental disorders and psychiatric patients; see for a review: [1
]. These studies focussed on to what extent mental disorders are recognised as such and examined the prevailing beliefs about the causes and treatment of these illnesses among the public. The majority of these studies used case vignettes describing a person with either depression or schizophrenia. Five major findings can be concluded from these population studies. First, many members of the general public could not correctly recognise mental disorders [2
]. Second, public beliefs about the causes of mental disorders and the effectiveness of various treatments differed greatly from those of mental health professionals [5
]. Third, a widespread stigma was found towards those who suffer from a mental disorder, especially people with schizophrenia [8
]. Four, in the majority of studies where the influence of socio-demographic characteristics on beliefs about psychiatric patients was examined, older age, lower education and less familiarity with mental illness were associated with lower tolerance [12
]. The studies did not focus on correlates of a positive attitude towards various treatment options. Five, the few which examined comparisons within and between countries revealed cultural differences in beliefs about mental disorders and psychiatric patients [13
]. However, the comparisons made focussed on different cultures, resulting in a fragmented and incomplete picture of these differences.
The public’s beliefs about the helpfulness of interventions for mental disorders and about psychiatric patients, such as perceiving the mentally ill as dangerous, untrustworthy or having poor social skills, may affect people’s perception of mental health services and the sorts of help they would seek in case of mental health problems [16
]. It is definitely not enough to have evidence-based treatments available if the public does not perceive mental health care as an effective means in dealing with emotional problems or alcohol or drugs problems. However, the prevailing attitudes towards seeking professional help for such problems and to what extent these beliefs actually influence service use for mental health problems are, to our knowledge, not yet investigated on a large scale in Europe.
The studies that focussed on correlates of a positive attitude towards seeking professional help for mental health problems are limited, and were mostly performed in the USA and Canada. They found that prior experience with the mental health care system was associated with a more positive attitude towards help-seeking [19
]. More favourable attitudes were also found among women [22
] and younger people [23
]. The studies that investigated to what extent attitudes play a role in the use of services for mental health problems in the general population are also limited, and were mostly performed in Australia. One study found that belief in professional help was a significant predictor of actually seeking help for mental health problems [25
]. Another study reported that beliefs about the helpfulness of an intervention did not always predict actual use of that intervention. It depended upon the particular intervention. Beliefs did predict use of antidepressants, but not counselling by a general practitioner or mental health professional in case of a mental health problem, even after adjustment for socio-demographic characteristics, previous depression and number of anxiety and depression symptoms [27
]. In contrast, a third study among young adults found that beliefs about the effectiveness of mental health treatment were associated with use of mental health services, after controlling for socio-demographic characteristics, mental health symptoms and subjective need [28
The few studies which have examined correlates of a positive attitude towards seeking professional help for mental health problems and to what extent such attitude actually influences mental health care use have two major limitations. They were not based on a large representative sample of the general population, and the findings were not controlled for the presence of a mental disorder. It is conceivable, however, that persons with a mental disorder differ in their opinion towards mental health care based on their experience or mental state. To effectively organise health education campaigns, more information is needed about how the general public and certain patient groups differ in their perception of the mental health care sector as an effective means in dealing with emotional problems, and subsequently to what extent attitude towards mental health care is a significant predictor of service use.
This paper attempts to fill this lack of knowledge by addressing three questions in a general population study performed in six European countries, using the Composite International Diagnostic Interview to determine attitudes towards health care and psychiatric diagnoses:
- What are the prevailing attitudes towards mental health help-seeking in Europe?
- What are correlates of these attitudes?
- To what extent are these attitudes associated with actual service use for mental health problems?