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Does Self-Stigma Reduce the Probability of

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Journal of Counseling Psychology
Does Self-Stigma Reduce the Probability of Seeking
Mental Health Information?
Daniel G. Lannin, David L. Vogel, Rachel E. Brenner, W. Todd Abraham, and Patrick J. Heath
Online First Publication, August 31, 2015. http://dx.doi.org/10.1037/cou0000108

CITATION
Lannin, D. G., Vogel, D. L., Brenner, R. E., Abraham, W. T., & Heath, P. J. (2015, August 31).
Does Self-Stigma Reduce the Probability of Seeking Mental Health Information?. Journal of
Counseling Psychology. Advance online publication. http://dx.doi.org/10.1037/cou0000108
 Journal of Counseling Psychology 2015 American Psychological Association
2015, Vol. 62, No. 4, 000 0022-0167/15/$12.00 http://dx.doi.org/10.1037/cou0000108

BRIEF REPORT

Does Self-Stigma Reduce the Probability of Seeking Mental

Health Information?
Daniel G. Lannin, David L. Vogel, Rachel E. Brenner, W. Todd Abraham, and Patrick J. Heath
Iowa State University

An important first step in seeking counseling may involve obtaining information about mental health
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

concerns and treatment options. Researchers have suggested that some people may avoid such informa-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

tion because it is too threatening due to self-stigma and negative attitudes, but the link to actual
help-seeking decisions has not been tested. Therefore, the purpose of the present study was to examine
whether self-stigma and attitudes negatively impact decisions to seek information about mental health
concerns and counseling. Probit regression models with 370 undergraduates showed that self-stigma
negatively predicted decisions to seek both mental health and counseling information, with attitudes
toward counseling mediating self-stigmas influence on these decisions. Among individuals experiencing
higher levels of distress, the predicted probabilities of seeking mental health information (8.5%) and
counseling information (8.4%) for those with high self-stigma were nearly half of those with low
self-stigma (17.1% and 15.0%, respectively). This suggests that self-stigma may hinder initial decisions
to seek mental health and counseling information, and implies the need for the development of early
interventions designed to reduce help-seeking barriers.

Keywords: self-stigma, attitudes, counseling, help seeking, mental health

Gathering information related to mental health concerns and
counseling may constitute an important first step in seeking coun-
seling (Oh, Jorm, & Wright, 2009; Rogers, 2008). Individuals may
want to know if their symptoms warrant seeking help (i.e., severe
enough; diagnosable), and what treatment options are available
before making a decision. Compared to those who do not seek
counseling, those who eventually seek counseling are more likely
to have first sought out information (Ybarra & Eaton, 2005).
Unfortunately, many people may still avoid or delay accessing
mental health and counseling information when they need it the
most because of concerns about self-stigma (Lannin, Guyll, Vogel,
& Madon, 2013; Vogel, Wade, & Haake, 2006) and negative
attitudes toward counseling (Vogel, Wade, & Hackler, 2007). To
better develop interventions that empower people to gather the
necessary information to make informed decisions about seeking
counseling, it is important to examine a theoretical model that
explains why people avoid taking these first steps in the help-
seeking process (i.e., obtaining relevant information). Therefore,
the purpose of the present study was to examine the effects of
self-stigma and attitudes toward counseling on peoples decisions
to seek mental health and counseling information.
Daniel G. Lannin, David L. Vogel, Rachel E. Brenner, W. Todd Abra-
ham, and Patrick J. Heath, Department of Psychology, Iowa State Univer-
sity.
Correspondence concerning this article should be addressed to Daniel G.
Lannin, W112 Lagomarcino Hall, Department of Psychology, Iowa State
University, Ames, IA 50011-3180. E-mail: dglannin@iastate.edu
Self-Stigma Heightens the Threat Associated With
Seeking Counseling
Self-stigma corresponds to the negative self-perceptions and de-
moralization that occur when societal stigma regarding mental health
and counseling is internalized and applied to the self (Corrigan, 2004;
Kranke, Floersch, Townsend, & Munson, 2010; Manos, Rsch,
Kanter, & Clifford, 2009; Vogel, Bitman, Hammer, & Wade, 2013;
Vogel et al., 2006). Self-stigma threatens positive self-conceptions
that individuals are strongly motivated to protect (Lannin et al., 2013;
Vogel et al., 2013). For example, self-stigmatizing labels associated
with seeking counseling include insecure, inadequate, inferior, weak,
and disturbed (King, Newton, Osterlund, & Baber, 1973; Sibicky &
Dovidio, 1986), which contradict positive labels such as competent,
adequate, and stable (Sherman & Cohen, 2006). As such, people may
avoid counseling (Fisher, Nadler, & Whitcher-Alagna, 1982; Lannin,
Vogel, Brenner, & Tucker, 2015; Wade, Post, Cornish, Vogel, &
Tucker, 2011) and counseling-related information to reduce the threat
associated with self-stigma and protect positive self-conceptions
(Lannin et al., 2013).
When counseling is viewed as threatening, individuals are likely to
perceive it more negatively (Bayer & Peay, 1997; Codd & Cohen,
2003; Hammer & Vogel, 2013; Mo & Mak, 2009; Schomerus,
Matschinger, & Angermeyer, 2009; Vogel et al., 2006). Self-stigma
has been linked to more negative attitudes toward individual coun-
seling (e.g., Vogel et al., 2006), career counseling (Ludwikowski,
Vogel, & Armstrong, 2009), and group counseling (Shechtman, Vo-
gel, & Maman, 2010). In addition, self-stigma has been linked to
decreased intentions and willingness to seek counseling (Hammer &
Vogel, 2013; Lannin et al., 2015; Wade et al., 2011). Previous

1
 2 LANNIN, VOGEL, BRENNER, ABRAHAM, AND HEATH

research has found that ones attitudes toward counseling mediates the
relationship between self-stigma and intentions to seek counseling
(Pederson & Vogel, 2007; Vogel et al., 2007). In other words, self-
stigma may reduce a persons intentions to seek counseling because
self-stigma may erode positive attitudes toward counseling. However,
one limitation of previous research is that it has often relied on
self-reported outcome variables while not examining actual help-
seeking decisions. Therefore, the present study examines decisions to
seek mental health and counseling information.
Current Study
In the current study, we investigated whether the relationships
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
may be mediated by attitudes toward counseling, a possibility sup-
ported by previous research (Pederson & Vogel, 2007; Vogel et al.,
2007). Consequently, we also hypothesized that attitudes pertaining to
psychological counseling would mediate the negative association due
to self-stigma (see Figure 1B) on decisions to seek mental health and
counseling information. Specifically, we predicted that self-stigmas
negative associations with decisions to seek mental health and coun-
seling information would be due to its negative association with
attitudes toward counseling. Finally, previous studies have found that
being female and having greater levels of distress are associated with
an increased likelihood of seeking treatment (e.g., Lannin et al., 2015;
Addis & Mahalik, 2003). Therefore, we controlled for the influence of
these variables in our models.

between self-stigma and attitudes toward counseling apply to actual

This document is copyrighted by the American Psychological Association or one of its allied publishers.

decisions to seek mental health and counseling information. Self-

stigma represents a threat to positive self-perceptions that may be Method
activated when considering whether or not to seek mental health and
counseling information. Therefore, we first hypothesized that people Participants
with higher self-stigma would be less likely to seek information about
mental health concerns and counseling (Figure 1A). It is also likely A total of 370 undergraduates from a large Midwestern univer-
that self-stigmas negative impact on decisions to seek information sity were recruited to participate in the study through announce-

C Info
A

Distress
-

Self- gma

-
Gender +

MH Info

C Info
B
Distress
+

-
Self- gma tudes

Gender

MH Info

Figure 1. Conceptual direct effect model (A) and fully mediated model (B). Hypothesized paths are repre-
sented by dark lines with hypothesized directions of effects depicted by or . Covariates are represented by
dotted lines. C Info Participants decision to obtain counseling information; MH Info participants decision
to obtain mental health information. C Info and MH Info are dummy coded, such that 0 no and 1 yes.
Gender is effects-coded, such that 1 female and 1 male.
 SEEKING MENTAL HEALTH INFORMATION
ments in their psychology and communication studies classes
(female 61%; age, M 19.4, SD 1.77, range 17 41). The seling in the future. Five items are reverse-scored so that higher
sample included first-year students (56%), second-year students
(24%), third-year students (11%), fourth-year students (7%), and
other (2%). Participants were European American (82%), Asian
American/Pacific Islander (7%), Latino/a (4%), African American
(4%), multiracial (2%), and other (1%). Sexual orientations in-
cluded heterosexual (94%), bisexual (3%), questioning (1%), self-
identifying (1%), gay (1%), and lesbian (1%).
Procedures
After voluntarily agreeing to participate and providing informed
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consent, participants completed an online survey using Qualtrics
This document is copyrighted by the American Psychological Association or one of its allied publishers.
software in exchange for class credit. The survey included demo-
graphic questions, assessments of stigma (Self-Stigma of Seeking
Help scale [SSOSH]; Vogel et al., 2006), help-seeking attitudes
(Attitudes Toward Seeking Professional Psychological Help Scale
[ATSPPHS]; Fischer & Farina, 1995), and psychological distress
(K6; Kessler et al., 2002). After participants completed these
survey items, two help-seeking decisions were obtained. Partici-
pants were first asked if they would like to be directed to the
University Student Counseling Service website where they can
learn more about seeking help from a psychologist. Affirmative
responses opened a new tab in the web-browser that directed
participants to the Universitys Counseling Service website. Re-
gardless of whether or not they chose to seek counseling informa-
tion, all participants were then asked if they would like to be
directed to a website that provides more information about mental
health concerns. Affirmative responses opened a new tab in the
web-browser that directed participants to a mental health website
designed for college students (The Jed Foundation). Thus, all
participants could choose to seek information about counseling
services, mental health concerns, both, or neither. University hu-
man subject approval was obtained for all study procedures prior
to data collection.
Measures
Self-stigma. The SSOSH (Vogel et al., 2006) was used to
measure participants self-stigma related to seeking professional
counseling. The 10-item scale includes items such as If I went to
a therapist, I would be less satisfied with myself (Vogel et al.,
2006, p. 328). Items are rated on a 5-point scale from 1 (strongly
disagree) to 5 (strongly agree). Five items are reverse-scored so
that higher scores correspond to higher self-stigma related to
seeking counseling. Previous support for the validity of the
SSOSH scale has indicated positive associations with assessments
of societal stigma of seeking counseling, anticipated risks of dis-
closing in therapy, and negative associations with assessments of
attitudes toward seeking professional counseling and intentions to
seek counseling (Vogel et al., 2006). The SSOSH has shown high
internal consistency ( .86 .90) and 2-month testretest reli- ified as covariates, and counseling information and mental
ability (.72) in undergraduate samples (Vogel et al., 2006), with
similar internal consistency in this sample ( .87).
Attitudes toward counseling. Attitudes were assessed using
the short form of the ATSPPHS (ATSPPHS-SF; Fischer & Farina,
1995). This scale has 10 items that are answered on a 4-point scale
with responses ranging from 0 (disagree) to 3 (agree), and in-
3
cludes items such as I might want to have psychological coun-
scores indicate more positive attitudes. Previous findings support
the validity of the scale, with scores on the ATSPPHS-SF being
negatively associated with assessments of self-stigma and posi-
tively associated with assessments of help-seeking intentions (e.g.,
Vogel et al., 2007). Internal consistency of this scale has ranged
from .79 to .82 in undergraduate samples (Fischer & Farina, 1995;
Pederson & Vogel, 2007), with similar internal consistency in this
sample ( .81).
Psychological distress. The Self-Administered K6 (Kes-
sler et al., 2002) was used to assess psychological distress. This
6-item measure of psychological distress was developed for use
in the U.S. National Health Interview Survey. Participants read
the sentence stem, during the past 30 days, about how often did
you feel . . . and rate items such as nervous and hopeless
on a 5-point Likert scale from 1 (all the time) to 5 (none of the
time). A distress score is calculated by converting the scale
items such that 0 none of the time and 4 all of the time, and
then summing all converted items. Epidemiological research
has found that scores above 5 indicate moderate psychological
distress, appropriate for seeking help, and scores above 13
suggest the likely presence of a serious mental illness, defined
as a DSMIV disorder occurring in the last 12 months
(Prochaska, Sung, Max, Shi, & Ong, 2012). Previous research
has provided support for the validity of the K6 due to its
ability to discriminate between clinical and nonclinical popu-
lations, as well as internal consistency ranging from .89 to .92
(Kessler et al., 2002), with similar internal consistency in this
sample ( .84).
Results
Descriptive and Preliminary Analyses
First, missing data were examined and found to range from 0%
to 1.9% across all items. Of the 370 participants who began the
survey, 98% completed all measures. Descriptive statistics and
bivariate intercorrelations were calculated for all study variables
and are displayed in Table 1. In the present sample, the mean
distress score was equal to 7.51 (SD 4.65), indicative of mod-
erate psychological distress (Prochaska et al., 2012).
Self-Stigmas Influence on Decisions to
Seek Information
The relationship of self-stigma and decisions to acquire in-
formation was explored by using a robust weighted least
squares approach (i.e., WLSMV estimator in Mplus 6), an
approach that functions well with sample sizes of 200 or larger
(Brown, 2006; Muthn, du Toit, & Spisic, 1997). Self-stigma
was specified as a predictor variable, distress and gender spec-
health information as categorical outcome variables. To aid
interpretation of results, all continuous predictor variables were
standardized. Effects coding for gender (1 male, 1
female) causes the effect associated with being male versus
female to equal twice the reported coefficient, but also allows
for averaging across genders (i.e., when gender is specified as
 4 LANNIN, VOGEL, BRENNER, ABRAHAM, AND HEATH

Table 1
Intercorrelation Matrix of All Study Variables (N 370)

Variables 1 2 3 4 5 6

Predictor variables
1. Distress .08 .10 .05 .15 .23
2. Gender .08 .08 .19 .01 .00
3. Self-Stigma .12 .07 .56 .08 .11
4. Attitudes .03 .17 .60 .16 .17
Outcome variables
5. C Info .20 .01 .08 .15 .42
6. MH Info .26 .00 .11 .16 .42
M (SD) 7.51 (4.65) Female 61% 2.75 (.68) 1.61 (.52) Yes 7.3% Yes 7.0%
Note. Pearsons product-moment correlation coefficients (parametric) are shown below the diagonal; Spear-
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mans rank-order correlation coefficients (nonparametric) are shown above the diagonal. Distress K6;
Self-Stigma Self-Stigma of Seeking Psychological Help scale; Attitudes short form of the Attitudes Toward
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Seeking Professional Psychological Help Scale; C info participants decision to obtain counseling informa-
tion; MH Info participants decision to obtain mental health information. C Info and MH Info are dummy
coded, such that 0 no and 1 yes. Gender is effects-coded, such that 1 female and 1 male.

p .05. p .01. p .001.

0). The two outcome variablesmental health information and
counseling informationwere each dummy coded such that
0 no and 1 yes. Estimation of path coefficients to cate-
gorical outcome variables under WLSMV estimation in Mplus
uses a probit function, which is based on a cumulative normal
probability distribution of z-scores. In the present models, the
values of path coefficients represent the increase/decrease of a
z-score, which in turn corresponds to the probability of seeking
information. For standardized variables, the values of 1 and 0
are particularly meaningful. For the current results, standard-
ized variables allow the reader to interpret path coefficients to
representing the change in z-score for a person who scores 1 SD
above the mean on the self-stigma measure compared to that of
a person who scores at the mean of the self-stigma measure.
As shown in Figure 2, the model testing the direct effects of
stigma on decisions to seek information demonstrated good fit to
the data, 2(0, N 370) 0.00, p .00; comparative fit index
(CFI) 1.000; Tucker-Lewis index (TLI) 1.000; root mean
square error of approximation (RMSEA) .000, 90% confidence
interval (CI) .000, .000], which is expected because this model
Self-stigmas indirect effects. To examine the potential me-
diating role of attitudes we reran the above model with attitudes
included as a mediator. Namely, we specified a model in which
self-stigma predicted attitudes, and attitudes then predicted both
outcome variablesmental health information and counseling in-
formation (see Figure 3). Distress and gender were specified as
covariates, predicting attitudes, and both outcome variables.
A test of the hypothesized structural model resulted in a good fit
to the data, 2(2, N 370) 1.23, p .54; CFI 1.000; TLI
1.017; RMSEA .000, 90% CI .000, .089. In line with
recommendations to examine alternative models against the hy-
pothesized model (Martens, 2005), we compared the hypothesized
model against two alternative models. First, to rule out the possi-
C Info
2
R = .15
Distress

estimates all the associations among the measures. Results sup-

ported the hypothesis that people with higher self-stigma would be
less likely to seek information about both mental health concerns
and counseling. As shown in Figure 2, self-stigma was a signifi- 0.68 ***
Self-S gma
cant predictor of decisions to seek mental health information
( 0.33, SE 0.15, p .029, 95% CI for 0.63, 0.03)
and approached significance as a predictor of counseling informa-
tion ( 0.23, SE 0.14, p .097, 95% CI for 0.51, Gender +

0.04). Controlling for gender and distress, a calculation of pre-

dicted probabilities from predicted z-scores indicated that among
individuals with low self-stigma (1 SD), 8.7% of individuals
sought mental health information and 9.0% sought counseling
information, but among individuals with high self-stigma (1 SD)
only 2.2% sought mental health information and 3.5% sought
counseling information. Distress was also a significant predictor of
decisions to seek mental health information ( 0.55, SE 0.14,
p .001, 95% CI for 0.29, 0.82) and counseling information
( 0.39, SE 0.11, p .001, 95% CI for 0.18, 0.59).
Gender was not predictive of either decision to seek information,
both ps .47.
MH Info
2
R = .26
Figure 2. Direct effects of stigma on decisions to seek information.
Hypothesized paths are represented by dark lines. Covariates are repre-
sented by dotted lines. Distress K6; Self-Stigma Self-Stigma of
Seeking Help scale; C info Participants decision to obtain counseling
information. MH Info Participants decision to obtain mental health
information. C Info and MH Info are dummy coded, such that 0 no and
1 yes. Gender is effects-coded, such that 1 female and 1 male.
.05 p .10. p .05. p .001.
 SEEKING MENTAL HEALTH INFORMATION
C Info
2
R = .18
Distress
-0.60*** A tudes
Self-S gma 0.62***
2
R = .39
Gender
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MH Info
2
R = .29
Figure 3. Fully mediated model. Hypothesized paths are represented by
dark lines. Covariates are represented by dotted lines. Distress K6;
Self-Stigma Self-Stigma of Seeking Help scale; Attitudes short form
of the Attitudes Toward Seeking Professional Psychological Help Scale; C
Info Participants decision to obtain counseling information; MH Info
participants decision to obtain mental health information. C Info and MH
Info are dummy coded, such that 0 no and 1 yes. Gender is
effects-coded, such that 1 female and 1 male. p .05. p .01.
p .001.
bility that self-stigma mediated the effects of attitudes on both
outcome variables, we tested a model identical to the hypothesized
model, except that self-stigma now mediated the effects of atti-
tudes on both outcome variables. Although it is impossible to
compare this model to the hypothesized model via a chi-square
difference test because both models contain the same degrees of
freedom, this alternative structural model fit the data worse than
the hypothesized model, with the TLI below the cutoff point of .95
and RMSEA exceeding the critical cutoff point of .06 (Hu &
Bentler, 1999), 2(2, N 370) 4.86, p .09; CFI 0.989;
TLI 0.935; RMSEA .062, 90% CI .000, .135. Therefore,
we retained the hypothesized model.
Next, to rule out the possibility that attitudes may be a partial
mediator, we compared the hypothesized full mediation model
against a partial mediation model that contained two additional
paths over the fully mediated model: one from self-stigma to
mental health information and one from self-stigma to counseling
information. The direct paths from self-stigma to both outcome
variables were not significant (ps .35), and a chi-square differ-
ence test of the hypothesized full mediation versus partial media-
tion model indicated that the two models were not significantly
different from one another 2(2, N 370) 1.57, p .46.
Therefore, for parsimony we retained the hypothesized full medi-
ation model.1
Results provided support for the hypothesis that self-stigmas
negative association with decisions to seek mental health and
counseling information would be due to its negative association
with attitudes toward counseling. Self-stigma was a significant
predictor of more negative attitudes ( 0.60, SE 0.04, p
.001, 95% CI for [0.68, 0.52]). Attitudes toward coun-
seling, in turn, was a significant predictor of decisions to seek
mental health information ( 0.35, SE 0.13, p .007, 95%
5
CI for [0.09, 0.61]) and counseling information ( 0.29,
SE 0.10, p .004, 95% CI for [0.09, 0.48]). Furthermore,
there were statistically significant indirect effects of self-stigma
through attitudes on both mental health information ( 0.21,
SE 0.08, p .004, 95% CI for [0.37, 0.06]) and on
counseling information ( 0.17, SE 0.06, p .008, 95% CI
for [0.29, 0.06]). This finding is consistent with the
interpretation that self-stigma is associated with decreased atti-
tudes toward counseling, which then leads to decreased likelihood
of seeking mental health and counseling information.
Next, we were interested in examining how the indirect effect of
self-stigma through attitudes was associated with the predicted
probability of seeking mental health and counseling information
for individuals most at risk (i.e., those with high levels of distress).
For ease of interpretation, to calculate scores for individuals with
high distress we substituted distress scores of 1 SD into the
mediation model shown in Figure 3. In the present sample, indi-
viduals 1 SD above the mean on distress scored 12.16 on the
K6, which places them above the clinical cutoff for moderate
distress (scores of 5 and above) and approaching the clinical cutoff
for severe distress (scores of 13 and above) that has been identified
in an epidemiological validation study (Prochaska et al., 2012). To
calculate indirect effects of self-stigma we multiplied the path
from self-stigma to attitudes by the path from attitudes to the
relevant outcome variable (mental health information and coun-
seling information), then multiplied the indirect effect by either the
coefficient 1 or 1 to refer to high self-stigma (1 SD) or low
self-stigma (1 SD), respectively (MacKinnon & Dwyer, 1993).
Among individuals experiencing higher levels of distress, the
predicted probability of seeking mental health information for
people with high self-stigma was 8.5% whereas the probability for
those with low self-stigma was 17.1%. Results for counseling
information were of a similar direction and magnitude. Among
individuals experiencing higher levels of distress, the probability
of seeking counseling information for people for people with high
self-stigma was 8.4% whereas the probability for those with low
self-stigma was 15.0%.
Discussion
Building on previous work that has often relied on self-report
outcomes, the present study examined the harmful effects of self-
stigma on early help-seeking decisions. We hypothesized that
people with higher self-stigma would be less likely to decide to
1
Some participants sought both mental health and counseling informa-
tion (participants seeking counseling information only 4.1%; partici-
pants seeking mental health information only 3.8%; participants seeking
both types of information 3.2%). Therefore, we also examined a model
wherein the two outcome variables were collapsed into a single variable,
coded such that 0 sought no information and 1 sought either or both
types of information. This model also fit the data well, but fit indices were
slightly worse than the hypothesized model, 2(1, N 370) 1.60, p
.21; CFI 0.997; TLI 0.982; RMSEA .040, 90% CI .000, .151.
The direction and statistical significance of both the direct and indirect
effects were not meaningfully different from the hypothesized model.
However, we retained the hypothesized model because less than half of
information-seekers sought both types of information, and previous re-
search has suggested that seeking mental health information may be
differently stigmatizing than seeking counseling information (e.g., Lannin,
Vogel, Brenner, & Tucker, 2015).
 6 LANNIN, VOGEL, BRENNER, ABRAHAM, AND HEATH
seek mental health and counseling information. Results supported
this hypothesis, indicating that self-stigma was significantly asso-
ciated with the decreased probability of seeking online mental
health information and marginally significantly associated with the
decreased probability of seeking counseling information. This
supports the notion that people may avoid information that high-
lights their mental health concerns in order to reduce threats
associated with self-stigma (Lannin et al., 2013). The use of
observable outcome measures decisions to seek information
provides validation to and extends the findings of previous studies
that have examined the impact of self-stigma on self-reported
help-seeking outcomes (e.g., Vogel et al., 2006; Lannin et al.,
2015). This suggests that self-stigma is a threat with observable
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consequencesreducing the likelihood that an individual will seek
This document is copyrighted by the American Psychological Association or one of its allied publishers.
materials that are relevant to directly addressing their mental
health concerns.
We also hypothesized that attitudes toward counseling would
mediate the effects of self-stigma on decisions to engage with
online information. Results also supported this hypothesis. The
present studys mediation model provides initial evidence that
self-stigma influences decisions to seek mental health and coun-
seling information through its negative association with attitudes
toward counseling. Overall, these findings add to the literature by
investigating the psychological processes that impact an important
initial step in the help-seeking processseeking relevant informa-
tion. The present results bolster the notion that self-stigma asso-
ciated with seeking counseling represents a threat that erodes
positive attitudes toward counseling, and suggest that this psycho-
logical process hinders the probability of engaging in important
help-seeking behaviors. Specifically, in the present study, individ-
uals with high self-stigma were less likely to seek both mental
health and counseling information than those with low self-stigma.
Importantly, this relationship was also present for those most at
risk (i.e., highest in distress).
Not surprisingly, greater distress was strongly associated with
greater probability of seeking both mental health and counseling
information. This supports the notion that distress motivates deci-
sions to obtain help-seeking information. In addition, in line with
Addis and Mahalik (2003), being male was associated with worse
attitudes toward counseling. However, gender was not a statisti-
cally significant predictor of decisions to seek information about
mental health concerns or counseling. It is possible that the rela-
tively anonymous and unthreatening context of seeking online
information was responsible for allowing men with worse attitudes
toward counseling to still seek mental health and counseling in-
formation. Examining the context in which help-seeking informa-
tion is offered may be an important area for future research.
The present study has important implications for psychoeduca-
tional efforts. Substantial resources have been allocated to develop
programs to encourage people with mental health concerns to seek
psychological counseling (e.g., American Psychological Associa-
tion, 2012; The Jed Foundation; National Alliance on Mental
Health, n.d.; National Institute of Mental Health, n.d.), and many
of these efforts provide very useful information that could be
helpful if accessed. However, our results suggest that even indi-
viduals in need (i.e., those experiencing distress) may be reluctant
to access this information if they are experiencing higher levels of
self-stigma. Thus, it is important to understand factors that impact
how that information is sought (or avoided). If distressed individ-
uals avoid engaging with relevant information about their mental
health concerns and counseling options, making informed deci-
sions regarding their recovery is difficult.
Self-stigma is a salient factor that may prompt many to avoid
seeking important information because it negatively influences
their attitudes toward counseling. Therefore, when designing
educational materials that cover mental health concerns and
counseling, it may be important to consider how and why these
materials might be threatening to individuals with self-stigma
(e.g., they activate fears about stigma, reduced self-esteem, and
the loss of important relationships; Corrigan, 2004). Although it
is important to continue to develop psychoeducational interven-
tions that can increase mental health literacy (Jorm, 2012), the
present study suggests that it may also important to mitigate the
threat of self-stigma to increase the likelihood that an individual
accesses psychoeducational information. If self-stigma hinders
engagement with educational materials, some of the effort in
creating high-quality psychoeducational materials may be
wasted.
Therefore, it may be useful to consider theory-based approaches
for mitigating self-stigmas negative impact on individuals deci-
sion to seek mental health and counseling information. Self-
affirmation theory offers one approach, predicting that a relatively
brief intervention can reduce the threat evoked by self-stigma and
can increase willingness to engage in help-seeking behaviors (Co-
hen & Sherman, 2014; Lannin et al., 2013; Steele, 1988). Self-
affirmation interventions highlight positive self-perceptions (e.g., I
am generous) unrelated to the negative self-perceptions triggered
by self-stigma (e.g., I am incompetent), which in turn buffer
self-worth from threats elicited by subsequent mental health and
counseling information. For example, Lannin et al. (2013) tested
an intervention wherein participants wrote about an important
personal value (i.e., self-affirmation) before reading an article that
described what counseling is and its benefits, and found that
self-affirmation reduced self-stigma and increased willingness to
engage in help-seeking behaviors. Such approaches may be useful
as direct attempts to change attitudes related to vulnerable aspects
of identity can actually intensify anxiety and increase resistance to
attitude change (Corrigan, 2004; Crocker & Park, 2004).
Developing brief self-affirmation interventions that can occur
online may constitute an important next step in mitigating
self-stigma because growing proportions of adults (18%; Pow-
ell & Clarke, 2006) and college students (31%; Horgan &
Sweeney, 2010) are browsing online resources to research their
mental health concerns. For many, accessing online information
may be an important first step that guides future decisions to
seek in-person help (Oh et al., 2009; Rogers, 2008). In partic-
ular, brief online self-affirmation activities could be imple-
mented on websites that (a) are commonly visited by identified
at-risk populations and (b) offer links to additional mental
health and treatment information (e.g., university webpages that
provide orientation information for new students, webpages
describing benefit information for veterans, and company web-
pages providing information about benefits and assistance pro-
grams for employees). In addition, outreach eventssuch as
those commonly implemented by University counseling cen-
ters could use self-affirmation-based interventions before
presenting mental health and counseling information.
 SEEKING MENTAL HEALTH INFORMATION
Limitations and Future Directions
Even though this study has many strengths, including its focus
on initial behavioral decisions in the help-seeking process, it also
has some limitations. First, the majority of the sample was Euro-
pean American with some college education. Previous research
indicates that the influence of stigma can differ depending on
ethnicity, race, and other cultural factors (Brown et al., 2010;
Vogel, Armstrong, et al., 2013; Vogel, Heimerdinger-Edwards,
Hammer, & Hubbard, 2011). To generalize to other relevant adult
populations, the results of the current study require replication with
samples diverse in ethnicity, age, and educational background.
Second, though we modeled the relationship between self-stigma
and attitudes with subsequent decisions to seek information, evi-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
dence of causal relationships is not conclusive because there may
This document is copyrighted by the American Psychological Association or one of its allied publishers.
be additional variables responsible for the observed correlations.
Future studies may therefore consider longitudinal designs or
experimental manipulations of self-stigma (or manipulating vari-
ables that approximate self-stigma) to examine self-stigmas
causal influence on decisions to engage with information about
mental health concerns and counseling. A third limitation is that
participants were asked whether they would like to be redirected to
websites about both mental health concerns and counseling, which
constitutes a relatively benign and anonymous help-seeking deci-
sion. A help-seeking decision that required participants to disclose
personal or identifying information (e.g., name or email) to obtain
information would have been more threatening and could have
resulted in stronger associations between self-stigma, attitudes,
and decisions to seek mental health or counseling information.
Nonetheless, the fact that the current study found statistically
significant effects within a relatively benign context provides
evidence for the robustness of the relationship between self-
stigma, attitudes, and help-seeking decisions. Finally, though this
study examined decisions to seek mental health and counseling
information around the same point in time, it is possible that
individuals may seek information more sequentially (i.e., mental
health information before seeking information about counseling).
Future research may benefit from examining how decisions to seek
information about mental health concerns influence subsequent
decisions to seek help for those concerns.
Conclusion
Results of the present study extend previous research, which has
found links between self-stigma, negative attitudes toward coun-
seling, and self-reported intentions to seek help. The present study
identifies self-stigma as an important barrier to initial decisions to
seek information about mental health concerns and counseling,
even for individuals with higher levels of distress. The present
study constitutes an initial step in understanding how psycholog-
ical processes attenuate adaptive help seeking and has important
implications for the development of early interventions designed to
increase mental health literacy and help-seeking behaviors.
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Received April 24, 2015
Revision received July 14, 2015
Accepted July 14, 2015