The impact of attitudes as a mediator between sense of autonomy and help-seeking intentions for self-injury

Chinese Medicine

Graham Martin¹  Megan Pumpa¹ 

[1] Department of Psychiatry, The University of Queensland, K Floor, Mental Health Building, RBWH, Herston 4006, Brisbane

关键词: Boot-strapping;    Mediation analysis;    Attitudes;    Autonomy;    Help-seeking;    Self-harm;    Self-injury;   

Others  :  1223172
DOI  :  10.1186/s13034-015-0058-3

 received in 2015-03-13, accepted in 2015-06-15,  发布年份 2015

【 摘 要 】

Background

Self-injury is a complex issue, further complicated by the fact that up to half of young people who self-injure do not receive help. Young people who do receive help for self-injury claim they prefer to access family and friends over more formal sources of help. This original research set out to examine the influence of negative attitudes to professional help and a sense of autonomy on help-seeking intentions.

Methods

A cross-section of 220 university students and young adults from the community (Students = 131, other participants = 89; mean age = 24.64) completed anonymous online questionnaires measuring self-injurious behaviour and mental health related problems, attitudes toward seeking professional mental health help, autonomy, and intentions to seek help for self-injury. Two separate mediation models were tested using a bootstrapping approach to investigate intentions to seek help – one on mental health problems, and one specifically on self-injury.

Results

More positive attitudes to help-seeking were significantly associated with greater intentions to seek help, while higher perceived autonomy was associated with lower intentions to seek help. Attitudes fully mediated the negative relationship between autonomy and willingness to seek help for self-injury. The model also maintained partial mediation for willingness to seek help for other mental health problems, beyond self-injury. Current self-injurers expressed significantly more negative attitudes toward help-seeking compared to past self-injurers and those with no history of self-injury. Similarly, current self-injurers reported being less likely to seek help from anyone compared to both other groups.

Conclusions

This study appears to be the first to set out to compare self-injurers’ attitudes to help-seeking directly with those of non-self-injurers, and the first to show that attitudes mediate the relationship between autonomy and help-seeking. The findings provide evidence that will assist development of interventions targeting negative attitudes toward seeking professional help, in order to increase help-seeking among self-injurers who would otherwise not receive treatment.

【 授权许可】

   
2015 Pumpa and Martin.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Rowe SL, French RS, Henderson C, Ougrin D, Slade M, Moran P. Help-seeking behaviour and adolescent self-harm: a systematic review. Aust N Z J Psychiatry . 2014; 48(12):1083-1095.
• [2]Klineberg E, Kelly MJ, Stansfield SA, Bhui KS. How do adolescents talk about selfharm: a qualitative study of disclosure in an ethnically diverse urban population in England. BMC Public Health. 2013; 13:572. BioMed Central Full Text
• [3]Fadum EA, Stanley B, Rossow I, Mork E, Tormoen AJ, Mehlum L. Use of health services following self-harm in urban versus suburban and rural areas: a national cross-sectional study. BMJ Open. 2013; 3:7.
• [4]Berger E, Hasking P, Martin G. ‘Listen to them’: adolescents’ views on helping young people who self-injure. J Adolesc. 2013; 36:935-45.
• [5]Fortune S, Sinclair J, Hawton K. Adolescents’ views on preventing self-harm. a large community study. Soc Psychiatry Psychiatr Epidemiol. 2008; 43:96-104.
• [6]Watanabe N, Nishida A, Shimodera S, Inoue K, Oshima N, Sasaki T et al.. Help-seeking behavior among Japanese school students who self-harm: results from a self-report survey of 18,104 adolescents. Neuropsychiatr Dis Treat. 2012; 8:561-9.
• [7]Fortune S, Sinclair J, Hawton K. Help-seeking before and after episodes of self-harm: a descriptive study in school pupils in England. BMC Public Health. 2008; 8:369. BioMed Central Full Text
• [8]Ystgaard M, Arensman E, Hawton K, Madge N, Van Heeringen K et al.. Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not. J Adolesc. 2009; 32:875-91.
• [9]Michelmore L, Hindley P. Help-seeking for suicidal thoughts and self-harm in young people: a systematic review. Suicide and Life-threatening Behavior. 2012; 42:507-524.
• [10]Leavey G, Rothi D, Paul R. Trust, autonomy and relationships: the help-seeking preferences of young people in secondary level schools in London (UK). J Adolesc. 2011; 34:685-693.
• [11]Nada-Raja S, Morrison D, Skegg K. A population-based study of help-seeking for self-harm in young adults. Aust N Z J Psychiatry. 2003; 37:600-605.
• [12]Vogel DL, Wester SR, Larson LM. Avoidance of counselling: psychological factors that inhibit seeking help. Journal of Counseling & Development. 2007; 85:410-422.
• [13]Wrigley S, Jackson H, Judd F, Komiti A. Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. Aust N Z J Psychiatry. 2005; 39:514-521.
• [14]Sibicky M, Dovidio JF. Stigma of psychological therapy: stereotypes, interpersonal reactions, and the self-fulfilling prophecy. Journal of Counselling Psychology. 1986; 33:148-154.
• [15]Komiti A, Judd F, Jackson H. The influence of stigma and attitudes on seeking help from a GP for mental health problems. Soc Psychiatry Psychiatr Epidemiol. 2006; 41:738-745.
• [16]Long M, Manktelow R, Tracey A. We are all in this together: working towards a holistic understanding of self-harm. J Psychiatr Ment Health Nurs. 2013; 20:105-113.
• [17]Pisani AR, Schmeelk-Cone K, Gunzler D, Petrova M, Goldston DB, Tu X et al.. Associations between suicidal high school students’ help-seeking and their attitudes and perceptions of social environment. Journal of Youth & Adolescence. 2012; 41:1312-1324.
• [18]Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems? Med J Aust. 2007; 187:35-39.
• [19]Wilson C, Rickwood DJ, Bushnell JA, Caputi P, Thomas SJ. The effects of need for autonomy and preference for seeking help from informal sources on emerging adults’ intentions to access mental health services for common mental disorders and suicidal thoughts. Advances in Mental Health. 2011; 10:29-38.
• [20]Wilson C, Deane FP. Brief report: Need for autonomy and other perceived barriers relating to adolescents’ intentions to seek professional mental health care. J Adolesc. 2012; 35:233-237.
• [21]Rotolone C, Martin G. Giving up self-injury: a comparison of everyday social and personal resources in past versus current self-injurers. Archives of Suicide Research. 2012; 16:147-158.
• [22]Fischer EH, Turner JL. Orientations to seeking professional help: development and research utility of an attitude scale. J Consult Clin Psychol. 1970; 35:79-90.
• [23]Wilson C, Deane FP, Ciarrochi J, Rickwood D. Measuring help-seeking intentions: properties of the general-help-seeking questionnaire. Can J Couns. 2005; 39:15-28.
• [24]Goldberg DP, Hillier VF. A scaled version of the general health questionnaire. Psychol Med. 1979; 9:139-145.
• [25]Hayes AF, Preacher KJ. Statistical mediation analysis with a multicategorical independent variable. Br J Math Stat Psychol. 2013; 67:451-470.
• [26]Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behaviour Research Methods. 2008; 40:879-891.
• [27]Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51(6):1173-1182.
• [28]Fritz MS, MacKinnon DP. Required Sample Size to Detect the Mediated Effect Psychological Science. 2007; 18:3,233-239.
• [29]Martin G, Swannell S, Hazell P, Harrison J, Taylor A. Self-injury in Australia: a community survey. Med J Aust. 2010; 193(9):506-510.
• [30]Muehlenkamp JJ, Gutierrez PM. An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide and Life-Threatening Behavior. 2004; 34:12-23.
• [31]Hawton K, Rodham K, Evans E, Harriss L. Adolescents who self harm: a comparison of those who go to hospital and those who do not. Child Adolesc Mental Health. 2009; 14:24-30.
• [32]Evans E, Hawton K, Rodham K. In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? J Adolesc. 2005; 28:573-587.
• [33]Muehlenkamp J, Walsh B, McDade M. Preventing non-suicidal self-injury in adolescents: the signs of self-injury program. Journal of Youth and Adolescence. 2010; 39:306-314.