Abstract
Despite a comparable need, research has indicated that on average men hold more negative attitudes toward psychological help seeking than women. Several researchers have suggested that the gender gap in service use and attitudes could be addressed through efforts to better market psychological services to men; however, a limited number of studies have tested this hypothesis. This study examined whether altering the labels for mental health providers (psychologist or counselor), settings (mental health clinic or counseling center), and treatments (problem or feeling focused) could result in less perceived stigma (social and self) by men. Participants, 165 male college students, were asked to read one of eight randomly assigned vignettes that described a man who was experiencing symptoms of depression and was considering seeking help. The vignettes differed in the labels that were used to describe the help that was being considered. Participants then completed measures assessing the stigma (self and social) associated with the treatment, and their preexisting experience of gender-role conflict and attitudes toward psychological help seeking. In summary, perceived stigma did not depend on the type of label that was used; however, 59% of the variance in attitudes was predicted by self-stigma (uniquely explaining 11%), gender-role conflict (uniquely explaining 10%), and social stigma (uniquely explaining 5%). Specifically, higher levels of gender-role conflict, social stigma, and self-stigma were associated with more negative attitudes toward psychological help seeking. Based on the demographics of the sample, these findings primarily have implications for Caucasian college-educated young adult men. Further limitations with the study and recommendations for future research are discussed.
Despite comparable levels of stress, men, on average, have been reported to be less likely to seek mental health services compared with women (Ang, Lim, Tan, & Yau, 2004; Good & Wood, 1995; McKelley, 2007; Pederson & Vogel, 2007). This finding has been demonstrated across ethnic groups, disorders, and settings (Galdas, Cheater, & Marshall, 2004; Husaini, Moore, & Caine, 1994; Pederson & Vogel, 2007). Perhaps explaining the lower level of service use by many men (Bayer & Peay, 1997; Mackenzie, Gekoski, & Knox, 2006; Nam et al., 2013; Vogel, Wade, & Hackler, 2007; Vogel & Wester, 2003), studies have also consistently indicated that men, when compared with women, hold more negative attitudes toward help seeking for mental health problems (Ang et al., 2004; Mackenzie et al., 2006; Pederson & Vogel, 2007). In one meta-analysis that included 16 studies and 5,713 participants, Nam et al. (2010) identified a significant correlation (p < .001) between gender and attitudes toward seeking professional psychological help. Given these findings, it is important that researchers and providers alike seek to gain a better understanding of the variables that predict men’s help-seeking attitudes as well as identify ways to improve attitudes toward psychological service utilization in men.
Predicting Psychological Help–Seeking Attitudes in Men
Based on the research indicating that men, on average, hold more negative attitudes toward psychological service utilization, several researchers have sought to identify the variables that act as barriers to seeking psychological help in men. In one review, Möller-Leimkühler (2002) suggested that many men may be less likely to seek out psychological help for problems such as depression because traditional masculinity norms encourage them to suppress or deny problems, because some symptoms of depression may be masked by other expression styles that are deemed more acceptable for men (i.e., anger, aggression, hostility), because emotional expression (a central component to many mental health treatments) in general is often discouraged in men, and because the act of help seeking can imply a loss of status and autonomy particularly for men. Similarly, several studies that have examined men’s reasons for seeking or not seeking help through interviews, focus groups, and analyses of media have similarly indicated that asking a professional for help is often perceived as a feminine activity and that men who do so would be seen as weak and less manly (Courtenay, 2000; Johnson, Oliffe, Kelly, Galdas, & Ogrodniczuk, 2012; O’Brien, Hunt, & Hart, 2005; Oliffe & Phillips, 2008). Along these lines, the two variables that have perhaps received the most empirical attention examining their relation to help-seeking attitudes in men are stigma and gender-role conflict (Blazina & Marks, 2001; Good & Wood, 1995; Nam et al., 2010; Pederson & Vogel, 2007; Robertson & Fitzgerald, 1992; Vogel, Wade, & Haake, 2006; Vogel et al., 2007).
The perception of stigma is one variable that likely plays a strong role in the more negative attitudes that some men hold toward mental health help seeking. Stigma is defined as a mark of disgrace that is given to individuals or groups that possess a socially undesirable characteristic or engage in an unacceptable behavior (Blaine, 2000; Vogel et al., 2007). According to Corrigan (2004), stigma includes both perceptions about how others might view an individual who engages in a certain behavior (social stigma) as well as perceptions about oneself for engaging in that behavior (self-stigma). In general, a high level of stigma toward seeking professional psychological help has been identified in both men and women (Mackenzie et al., 2006; Nam et al., 2013; Vogel et al., 2007). Research has indicated that, on average, men perceive an even higher level of stigma associated with mental health help–seeking behaviors than their female counterparts (Vogel et al., 2006, 2007). This is true for both perceptions of social stigma and self-stigma—thus not only do some men believe that seeking out psychological services would be frowned upon by society but also many men would personally view themselves more negatively if they sought out this type of help (Vogel et al., 2006, 2007; Vogel, Heimerdinger-Edwards, Hammer, & Hubbard, 2011). Given that the perception of stigma (both social and self) has been identified as one of the best predictors of help-seeking attitudes and intentions (Nam et al., 2013; Vogel et al., 2007), this variable helps explain why men, on average, hold more negative attitudes toward mental health treatments.
Gender-role conflict is another variable that likely plays a role in the more negative attitudes that men, on average, hold toward seeking professional psychological help (Addis & Mahalik, 2003). Gender-role conflict is defined as the negative cognitive, emotional, and behavioral consequences of engaging in acts that contradict stereotypical gender-role norms (Pederson & Vogel, 2007). The concept of hegemonic masculinity suggests that in many societies the ideal behaviors and attitudes associated with manhood are ones that lead to power and control (Connell & Messerschmidt, 2005). Thus, for some men (specifically those who more strongly espouse traditional masculine roles), many aspects associated with seeking professional psychological help can produce conflict—For those who espouse more traditional masculine roles and beliefs, the act of asking another person for help can be seen as a sign of weakness in men and talking about ones feelings is often seen as a more feminine activity (Good & Wood, 1995; Vogel et al., 2011). Research has indicated that male gender-role conflict is significantly associated with both stigma and attitudes toward seeking professional psychological help (Blazina & Marks, 2001; Robertson & Fitzgerald, 1992). In one often cited study, Good and Wood (1995) with a sample of 397 male college students reported that approximately 25% of the variance in attitudes could be explained by gender-role conflict. More particularly, they indicated that negative psychological help–seeking attitudes were best predicted by a view that acknowledging and expressing feelings/emotions conflicts with male social norms. Other studies examining the relationship between gender-role conflict and attitudes have reported similar results (Pederson & Vogel, 2007; Rochlen & O’Brien, 2002).
Addressing Negative Attitudes Toward Seeking Professional Psychological Help in Men
Psychological help seeking in men is a complex phenomenon that has been conceptualized in several ways (Wenger, 2011). In addition to the “rational choice” research that has been conducted attempting to identify the variables (such as stigma and gender-role conflict) that predict which men seek help, Wegner (2011) indicates that more dynamic research is needed “exploring when and how one seeks help” (p. 491). Along these lines, several researchers have suggested that methods for better marketing psychological services to men may assist with helping them become more comfortable with psychological interventions (Addis & Mahalik, 2003; McCarthy & Holliday, 2004; Rochlen & Hoyer, 2005; Vogel et al., 2007). In one early study of marketing psychological services to men, Robertson and Fitzgerald (1992) had 435 college students view brochures that described one of two types of psychological services. The first brochure described typical counseling services in which a provider and a client met individually to discuss the client’s concerns. The second brochure described other nontraditional counseling services such as classes, workshops, seminars, and videotapes that could be used to address the same concerns. Robertson and Fitzgerald reported that men with higher levels of gender-role conflict expressed a greater preference for the nontraditional services. In another similar study, Blazina and Marks (2001) had 110 college men read brochures that described psychotherapy, psychoeducation, or a men’s support group as potential treatments for a mental health problem. Blazina and Marks reported that men with higher levels of gender-role conflict had more negative reactions to the support group compared with psychoeducation, but no differences with traditional psychotherapy were identified. In a more recent study, McKelley and Rochlen (2010) had 209 men listen to or read a vignette of a man who was experiencing a conflict at work and was considering talking to either an executive coach or a psychologist. Contrary to their hypotheses, no differences in attitudes or stigma associated with the type of provider were reported.
While the previous three studies tested whether different types of treatments and providers would be rated more favorably and less stigmatizing by men, other research has examined whether simply changing the label and/or the description of the same treatment could produce similar effects. In a test of the “Real Men. Real Depression” campaign, Rochlen, McKelley, and Pituch (2006) had 209 college men read one of three brochures: one that contained facts and pictures specific to men, another identical brochure that was gender neutral, and a completely different gender neutral brochure that also addressed depression. They reported that the male specific brochure was rated more favorably by men with low gender-role conflict and low attitudes toward psychological help seeking compared with the other two types of brochures; however, the ratings of the three brochures did not differ for men with high gender-role conflict or low gender-role conflict and preexisting positive attitudes. More recently, Hammer and Vogel (2010) compared an updated version of the Rochlen et al. (2006) “Real Men. Real Depression” brochure with the original one. In their updated brochure, Hammer and Vogel used more “male-friendly” terms such as “mental health consultant” as an example provider and “solution-focused” for a description of the treatment approach. Although both the old and the new version of the brochure resulted in improved attitudes and decreased stigma, the new brochure resulted in greater improvements. In another study, Rochlen and O’Brien (2002) had 302 college men evaluate two different career counseling approaches—one that was described as problem-focused and one that was described as emotion-focused. In their study, a significant preference for the problem-focused approach was identified.
In summary, the existing literature provides some mixed support indicating that attempts to market psychological interventions so they are more “male-friendly” can improve men’s attitudes toward seeking psychological help. It appears that the positive effects may depend on what types of labels/descriptions are used (e.g., McKelley and Rochlen [2010] reported no difference between executive coach and psychologist, but Rochlen and O’Brien [2002] did report a difference between descriptions of the approach as having either a problem or emotion focus) and the pre-existing attitudes of the participants (e.g., Rochlen et al. [2006] reported that the male-focused brochure was only effective for men with low gender-role conflict and negative attitudes toward help seeking).
Aims of the Current Study
Many have suggested that further research aimed at addressing the barriers to seeking psychological help for some men is needed, particularly focusing on stigma and the gender-role conflict associated with help-seeking behaviors (Addis & Mahalik, 2003; Johnson et al., 2012; McCarthy & Holliday, 2004; Möller-Leimkühler, 2002; Rochlen & Hoyer, 2005; Vogel et al., 2007). Although the existing research does further our understanding of ways psychological interventions can be marketed so they have a greater appeal to men, some limitations with this research exist. First, some of the existing studies have only examined participants’ reactions/opinions about their particular brochure or service description, rather than examining whether the brochure/description could result in improved attitudes or decreased stigma. Second, those studies that have examined changes in stigma and attitudes toward psychological help seeking have primarily used a pre–post design. Participants may have been reluctant to change their attitudes or perceptions of stigma if they had already stated them earlier in the study. Third, studies have focused on comparing only a couple of different labels/descriptions (e.g., consultant or counselor) and further research is needed to examine whether other provider, setting, and treatment labels might be more appealing to men. Given these limitations and the mixed findings that have been observed in the existing studies, further research is needed to test other possible ways to describe psychological interventions in a more “male-friendly” way.
This study sought to test whether different provider (psychologist vs. counselor), treatment setting (mental health clinic vs. counseling center), and treatment focus (coping with problems vs. coping with feelings) labels could result in lower perceptions of both social and self-stigma toward seeking psychological help by men. Given the desire to test whether different ways of referring to the same/similar provider, setting, and treatment focus options could result in less stigma (rather than testing whether certain types of treatments and providers were less stigmatizing to men); options were chosen that could be used interchangeably by many clinicians, referrers, and agencies. It was hypothesized that the labels of psychologist, mental health clinic, and coping with problems would be associated with less stigma given that previous research has indicated that emotion/feeling focused interventions are viewed less favorably by men (Rochlen & O’Brien, 2002) and these labels imply a stronger disorder/problem focus compared with the emotion/feeling focus that is often associated with counseling.
The focus of this study was to examine the effect of these labels on perceptions of stigma rather than on attitudes toward psychological help seeking. While attitudes may be seen as a more stable construct and existing measures of attitudes ask about mental health treatments of all types, this study was able to test the stigma associated with the specific labels that were being compared. Given the research indicating that the effectiveness of previous brochures/descriptions depends to some degree on participants’ preexisting help-seeking attitudes and gender-role conflict (Rochlen et al., 2006), this study also tested whether the labels would work differently depending on participants’ scores on measures of these variables. With these aims and hypotheses in mind, this study takes a more “dynamic approach” (Wegner, 2011) to studying help seeking in men in that it examines one possible method for helping men recognize that professional psychological help is an acceptable source of support when there is a recognized need.
Method
Participants and Procedures
Participants were 165 male students who were recruited through a psychology department subject pool at a large Northwestern university. After providing informed consent and demographic information, participants were randomly presented with one of eight possible vignettes. Each vignette described a man who had been experiencing symptoms of depression for the past 6 months (e.g., feeling down or blue most of the time, difficulty finding joy or pleasure with previously enjoyable activities, concentration difficulties, fatigue, feelings of worthlessness) and was now considering seeking professional help. The help he was considering was either from a psychologist or a counselor, at a mental health clinic or a counseling center, and would focus on coping with problems or feelings. Participants were then asked to complete measures assessing the stigma (self and social) associated with the treatment conditions, their general attitudes toward seeking professional psychological help, and their experience of gender-role conflict. The study was approved by the university’s institutional review board, was conducted entirely online, and took approximately 30 minutes to complete.
Measures
Gender-Role Conflict Scale–1
Gender-role conflict, a potential moderator for the hypotheses that were tested in this study, was measured with the Gender-Role Conflict Scale–1 (O’Neil, Helms, Gable, David, & Wrightsman, 1986). The Gender-Role Conflict Scale–1 is a 37-item self-report scale that assesses negative cognitive, emotional, and behavioral consequences associated with conforming to or violating male gender-role norms. Each of the 37 items is rated on a 6-point Likert-type scale, ranging from 1 (strongly disagree) to 6 (strongly agree). Total scores on the measure range from 37 to 222, with higher scores representing greater gender-role conflict and fear of femininity. Adequate levels of convergent and divergent validity for the measure have been reported (O’Neil, 2008). Furthermore, O’Neil et al. (1986) have reported a test–retest reliability ranging from r = .72 to .86 and an internal consistency of α = .89 for the measure. A similarly high level of internal consistency, α = .90, was identified with our sample.
Inventory of Attitudes Toward Seeking Mental Health Services
Attitudes toward psychological help seeking, a second moderator for the hypotheses that were tested, were measured with the Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS; Mackenzie, Knox, Gekoski, & Macaulay, 2004). The IASMHS was developed as an updated alternative to the Attitudes Toward Seeking Professional Psychological Help Scale (Fischer & Turner, 1970), another common measure of help-seeking attitudes. The IASMHS is a 24-item self-report measure with individual items being rated on a 5-point Likert-type scale, ranging from 0 (disagree) to 4 (agree). Total scores on the IASMHS range from 0 to 96, with higher scores indicating more positive attitudes toward mental health help–seeking behaviors. Mackenzie et al. (2004) have reported a test–retest reliability ranging from r = .64 to .91 and an internal consistency of α = .87 for the measure. Mackenzie et al. have also reported adequate convergent validity for the measure in that it accurately predicts previous and future use of mental health services. An internal consistency of α = .87 was identified with our sample for this measure.
Self-Stigma of Seeking Help
Self-stigma, one of the dependent variables of interest in this study, was measured with the Self-Stigma of Seeking Help Scale (Vogel et al., 2006). The Self-Stigma of Seeking Help Scale is a 10-item scale designed to measure a subjective sense of harm to self-esteem that results from seeking professional psychological help. Each item is rated on a 5-point Likert-type scale, ranging from 1 (strongly disagree) to 5 (strongly agree). Total scores on the measure range from 10 to 50, with higher scores reflecting greater self-stigma. Vogel et al. (2006) have reported a high level of internal consistency for the measure, α =.91. In the current study, the measure was adapted so that the wording was consistent with the help-seeking vignettes that were provided to participants, thus allowing for a test of the labels that were used as the independent variables. As an example of this adaptation, where the original measure included the item “Seeking psychological help would make me feel less intelligent,” for this study the item was adapted to read “Seeking help like described in the previous scenario would make me feel less intelligent.” As another example, while the original measure included an item that read “My self-esteem would increase if I talked to a therapist” (reverse coded), this item was adapted to read “My self-esteem would increase if I talked to a provider like the one described in the previous scenario.” The internal consistency of our adapted measure with our sample was α = .85.
Stigma Scale for Receiving Psychological Help
Social stigma, another dependent variable of interest in this study, was measured with the Stigma Scale for Receiving Psychological Help (Komiya, Good, & Sherrod, 2000). The Stigma Scale for Receiving Psychological Help is a 5-item self-report measure that was designed to assess worries of how others would view an individual who seeks professional psychological help. Each item is rated on a 4-point Likert-type scale, ranging from 1 (strongly disagree) to 4 (strongly agree). Total scores on the measure range from 5 to 20 with higher scores indicating a greater perception of social stigma for help seeking. Komiya et al. (2000) have reported an adequate level of internal consistency, α = .72, for the measure. This measure was also adapted for our study so that the wording was consistent with the help-seeking vignettes that were provided to participants, again allowing us to more adequately test the labels that were used as the independent variables. While the original measure included the item “Seeing a psychologist for emotional or interpersonal problems caries social stigma,” in the current study the item was adapted to read “Seeking a provider like the one described in the previous scenario carries social stigma.” An internal consistency of α = .74 was identified with our sample.
Data Analyses
The purpose of this study was to test whether the level of perceived stigma (social and self) differed depending on the particular provider, setting, and treatment labels that were used. Additionally, similar to the analyses that were conducted by Rochlen et al. (2006) in their test of the “Real Men. Real Depression” brochure, a focus of this study was to also test whether the effects of the labels depended on preexisting overall attitudes toward psychological help seeking and gender-role conflict. Using a median-split method, participants were first categorized as either having positive (n = 82) or negative attitudes (n = 77) toward psychological help seeking and high (n = 76) or low (n = 74) levels of gender-role conflict. Participants who did not complete the attitudes or the gender-role conflict measures were excluded from the remaining analyses. Two sets of 2 × 2 × 2 analyses of variance (ANOVAs) examining the influence of our labels on both social and self-stigma were then conducted. In the first set of ANOVAs, perceived levels of social and self-stigma for the two provider labels (psychologist vs. counselor) were compared with attitudes (positive vs. negative) and gender-role conflict (high vs. low) also entered as independent variables. In the second set of ANOVAs, perceived levels of social and self-stigma for the two setting labels (mental health clinic vs. counseling center) were compared, with attitudes and gender-role conflict also entered as independent variables. Last, in the third set of ANOVAs, perceived levels of social and self-stigma for the two treatment labels (problem vs. feeling-focus) were compared, with attitudes and gender-role conflict also entered as independent variables. This allowed for the testing of whether there was an overall difference depending on the label that was used (label main effects) as well as whether there was a difference between the labels depending on the level of preexisting attitudes and gender-role conflict (label by attitudes and label by gender-role conflict interactions). Given that the effects for both social and self-stigma were tested, a Bonferonni-corrected alpha of .025 was adopted for each set of tests.
Results
The average age of participants in this study was 25.97 years (SD = 8.50), ranging from 18 to 60 years. The sample was primarily single (78.2%) and identified as Caucasian (64.8%), with 9.1% of participants self-identifying as Asian American, 6.1% American Indian/Alaska Native, 4.8% African American, 10.3% Asian American, 4.8% Hispanic/Latino, 4.8% bi-multiracial, and 3.0% other. Significant differences between Caucasian and racial/ethnic minority participants were not observed for any of the main outcome and predictor variables included in this study (membership in the different conditions, self-stigma, social stigma, and attitudes), except for male gender-role conflict, t(148) = 2.20, p < .05, with racial/ethnic minority participants reporting greater experiences of gender-role conflict compared with Caucasian participants. Only 11% of participants were psychology majors, 30.9% of the sample had never taken a psychology course, and 92.1% had taken less than five.
Means and standard deviations for social and self-stigma for the provider label, setting label, and treatment label conditions are reported in Table 1. Independent-samples t tests were first conducted to compare levels of social and self-stigma between types of provider, setting, and treatment labels (results also reported in Table 1). In summary, significant differences in perceived levels of social and self-stigma between the label conditions were not present.
Means and Standard Deviations for the Different Label Conditions.
Note. CC = counseling center; MHC = mental health clinic.
Although significant differences between the label conditions were not indicated based on the results from the independent samples t-tests, it is possible that the influence of the labels on social and self-stigma depend on the level of participants’ preexisting attitudes toward mental health treatments and experience of gender-role conflict. Results of the 2 × 2 × 2 ANOVAs for both social and self-stigma are reported in Tables 2, 3, and 4. Similar to the results from the independent samples t-tests, none of the label main effects were significant for either social or self-stigma. Additionally, none of the interactions between the labels and attitudes or labels and gender-role conflict were significant for either perceptions of social or self-stigma.
Results of the 2 × 2 × 2 ANOVAs Comparing Levels of Social and Self-Stigma Between the Two Provider Labels.
Note. ANOVA = analysis of variance; GRC = gender-role conflict.
Results of the 2 × 2 × 2 ANOVAs Comparing Levels of Social and Self-Stigma Between the Two Setting Labels.
Note. ANOVA, analysis of variance; GRC = gender-role conflict.
Results of the 2 × 2 × 2 ANOVAs Comparing Levels of Social and Self-Stigma Between the Two Treatment Labels.
Note. ANOVA, analysis of variance; GRC = gender-role conflict.
Based on the findings from the ANOVAs indicating that participants with high and low attitudes and high and low gender-role conflict often differed in levels of social and self-stigma, a follow-up post hoc analysis was conducted to further examine the relationship between these variables. Previous research has identified stigma (Nam et al., 2013; Vogel et al., 2007) and gender-role conflict (Blazina & Marks, 2001; Good & Wood, 1995; Pederson & Vogel, 2007; Robertson & Fitzgerald, 1992; Rochlen & O’Brien, 2002) as significant predictors of attitudes toward mental health interventions in men; however, the existing research has primarily examined the relationship between these two predictors and attitudes separately. Thus, the purpose of this post hoc analysis was to examine the relative contributions of self-stigma, social stigma, and gender-role conflict when combined in a single model to predict attitudes in men. Given that none of the label main effects or their interactions with attitudes and gender-role conflict were significant, participants were collapsed across all of the label groups for these post hoc analyses. Correlations for these variables are reported in Table 5. A regression analysis indicated that for our male participants, variance in help-seeking attitudes was significantly predicted by the included variables, R = .77, F(3,145) = 68.38, p < .001. Results from this regression analysis are also reported in Table 5. Specifically, 59% of the variance in attitudes toward psychological help seeking was explained by the model. Each of the three variables were significant unique predictors of help-seeking attitudes, with self-stigma uniquely explaining approximately 11%, gender-role conflict uniquely explaining approximately 10%, and social stigma uniquely explaining approximately 5% of the variance in participants’ attitudes toward seeking psychological help. These results indicate that as men’s experiences of gender-role conflict, social stigma, and self-stigma increase, they experience more negative attitudes toward seeking psychological help.
Regression Results Predicting Help-Seeking Attitudes From Social Stigma, Self-Stigma, and Gender-Role Conflict.
p < .001.
Discussion
The purpose of this study was to examine whether the labels of psychologist compared with counselor, mental health clinic compared with counseling center, and problem-focus compared with emotion-focus would be perceived as less stigmatizing (social and self) by men. Contrary to our hypotheses, the perceived social and self-stigma did not differ significantly depending on which label was used. Furthermore, the lack of difference between the labels was consistent for male participants who held both positive and negative preexisting attitudes toward seeking professional psychological help and those with differing levels of gender-role conflict. Given the research that suggests that some men may avoid psychological help seeking because it is seen as a stigmatizing activity that is not associated with traditional concepts of masculinity (Courtenay, 2000; Johnson et al., 2012; Möller-Leimkühler, 2002; O’Brien et al., 2005; Oliffe & Phillips, 2008), the results of our study suggest that the various labels that we used did not alter that perception.
Although contrary to our original hypotheses, our results actually match the results of some other studies that have tested whether label changes would result in more positive help-seeking attitudes in men. McKelley and Rochlen (2010) reported no difference in attitudes toward seeking psychological help depending on whether the provider was called an executive coach or a psychologist. The results from the current study do differ from studies that have reported attitude differences toward various treatment options (Blazina & Marks, 2001; Robertson & Fitzgerald, 1992) in men. Additionally, our results differ from studies that have tested full brochures that have been designed to be more male-friendly (Hammer & Vogel, 2010; Rochlen et al., 2006). Perhaps, simply changing one or two labels (e.g., psychologist vs. counselor vs. executive coach) is not enough to change attitudes toward psychological interventions and the perception of stigma in college-educated men. It is possible that the studies that did identify differences did so because they used multiple labels, terms, and wording changes in their description of psychological services that could be considered consistent with male gender norms.
Although not the original focus of this study, social stigma, self-stigma, and gender-role conflict significantly predicted men’s attitudes toward seeking psychological help. Taken together, these variables predicted 59% of the variance in men’s help-seeking attitudes and each predictor explained a significant amount of unique variance in attitudes. These results match previous research that has separately reported that stigma (Nam et al., 2013; Vogel et al., 2007) and gender-role conflict (Blazina & Marks, 2001; Good & Wood, 1995; Pederson & Vogel, 2007; Robertson & Fitzgerald, 1992; Rochlen & O’Brien, 2002) predict psychological help–seeking attitudes. The significant relationship between gender-role conflict and attitudes in particular also supports the literature indicating that one of the reasons why men do not seek psychological help is because for some men doing so does not fit with beliefs about masculinity and male appropriate behaviors (Courtenay, 2000; Johnson et al., 2012; Möller-Leimkühler, 2002; O’Brien et al., 2005; Oliffe & Phillips, 2008) These results suggest that efforts to improve attitudes in college men should address both social and self-stigma as well as gender-role conflict.
Limitations
A number of limitations with this study should be considered. First, this study’s sample was composed of predominantly well-educated Caucasian men. Highly educated Caucasian men may be more familiar with mental health services, particularly those who have taken psychology courses in college. As a result of familiarity, our sample may have not identified the labels of “counselor,” “counseling center,” and “talking about feelings” as stigmatizing as a more diverse, less-educated group of men who have had less exposure to these topics (Addis & Mahalik, 2003; Gary, 2005; Good, Thomson, & Braithwaite, 2005; Shim, Compton, Rust, Druss, & Kaslow, 2009). Stigmatizing beliefs about mental health problems have been identified as a significant barrier to the utilization of mental health care for all populations; however, this is noted to be particularly true when considering minority populations (Schraufnagel, Wagner, Miranda, & Roy-Byrne, 2006). Racial/ethnic minority men who experience mental health problems may face stigma and discrimination at multiple levels due their experience of a mental illness, their race/ethnicity, and the possibility of seeking help as a male. Thus, additional research on mental health labels with a sample of racial/ethnic minority men would be useful. Second, participants in this study were only asked to consider the labels based on the possibility of seeking mental health help. Although our participants indicated that the labels did not influence the level of perceived stigma, it is not known if the labels would have an influence on actual help-seeking behavior. Third, there were only a few treatment labels used for comparison in this study. Using more labels in a study similar to this one may clarify whether it is the labels used in this study, or labels in general, that do not have an impact on men’s attitudes and intentions to seek help. Along the same lines, the labels that were used in this study may have been too similar for men to perceive a difference in stigma. Although counseling center, counselor, and seeking help with feelings were hypothesized to be less consistent with male social norms, men may actually see these terms as similar to psychologist, mental health clinic, and seeking help with problems. Future studies may want to use terms that are more distinct, such as mental health consultant for the provider and doctor’s office for the setting.
Conclusions and Future Directions
Even though this study failed to identify significant differences between label conditions, some clinical implications may be present. Based on the null results from this study, referrers, providers, and directors of agencies may not have to worry too much about the specific labels that they use when referring a Caucasian college-aged male patient to a mental health specialist—it may not make a difference if a general practitioner refers to the provider as a psychologist or counselor. Also, those who run a college clinic may not need to worry too much about calling the clinic a counseling center or a mental health clinic. However, these suggestions should be taken with caution given that they are based on null findings and given the limitations of the study.
In addition to addressing some of the limitations with this study, a number of future directions for this area of research exist. This study did indicate that perceptions of social and self-stigma and the experience of gender-role conflict significantly predicted men’s attitudes toward psychological help seeking. However, the labels that were tested did not result in less perceived stigma. Future research is needed to test other possible ways for addressing the gender-role conflict and stigma that is associated with help seeking for mental health problems for many men. This may include going beyond simply changing the labels of treatments and providing men with more complete education about the actual nature of many psychological interventions using male-friendly terms. This education can focus on describing how asking for mental health help is a sign of confidence, strength, and courage (characteristics that fit with male gender-role norms), rather than weakness or vulnerability. Additionally, efforts to raise awareness about the number of men who experience mental health problems and/or seek professional help for these types of issues may have positive results. Also, further research testing whether other activities that are more congruent with male gender-roles (e.g., sports, hands-on service activities, social activities/groups focused on topics of interest to men) can effectively be used as interventions for psychological disorders. Overall, more research is needed to gain a better understanding of the difficulty some men experience asking for psychological help. This research fits with a “dynamic approach” for understanding help seeking in men (Wegner, 2011), and could result in greater service utilization by men when there is a need, which in turn could result in healthier men who can better contribute to the well-being of their families and communities.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.