Kathleen Louden

April 01, 2014

CHICAGO — Despite large increases in depression and other mental health problems across the United States, today's college students are less comfortable about seeking mental health services, such as talk therapy, than their counterparts of 40 years ago, a new study shows.

Results of the 40-year cross-temporal meta-analysis of 22 studies that included nearly 6800 university students contradict previous research suggesting that individuals are becoming more comfortable with the idea of seeking treatment of mental illness.

The unexpected results prompted investigators to recheck their data, according to lead author Corey Mackenzie, PhD, a psychologist at the University of Manitoba, in Winnipeg, Canada.

"We were pretty sure we made a mistake, but that wasn't the case," Dr. Mackenzie told Medscape Medical News.

Instead, the researchers found a strong decrease over time in positive attitudes toward seeking mental health treatment — "a robust finding," according to Dr. Mackenzie.

Homogenous Sample

Presented here at the Anxiety and Depression Association of America (ADAA) Conference 2014, the study results likely reflect the increasing trend to treat depression more often with pharmacotherapy and less often with psychotherapy, Dr. Mackenzie told conference delegates.

"We argue that public education efforts to think of mental illness as a biological problem needing biological treatment are driving these changing attitudes," he said.

The investigators conducted the study to determine the effect of North American efforts during the past 2 decades to reduce stigma associated with seeking mental health treatment.

They compared all studies published through 2008 that used the full Attitudes Toward Seeking Professional Psychological Help Scale in US university students, first described in 1970 ( J Consult Clin Psychol. 1970;36:79-90).

The statistical analysis made bivariate correlations between mean scores on the scale (with higher scores reflecting more positive attitudes toward seeking help) and the year of data collection (estimated if not reported), rather than looking at effect size.

Dr. Mackenzie said they limited the sample to university students because published research employing this scale most often used them as participants, and they limited it to students in the United States to eliminate cross-cultural differences.

With a homogeneous sample, they believed that any differences they found across time would most likely be due to time rather than to differences in study samples.

Growing Negativity

The bivariate correlation between the year of data collection and the total mean score on the attitudes scale was significantly negative, r(44) = −0.53 (P < .01). According to the authors, this indicated that university students' help-seeking attitudes have become significantly more negative over time.

When the researchers weighted the data for sample size and study variance, Dr. Mackenzie said they achieved even stronger negative results: r(44) = −0.63 (P < .001). Looking at the magnitude of change, they found that the amount in decrease of scores over time was d = −.814, and scores declined by nearly 1 standard deviation during the 40-year period.

The findings made more sense, Dr. Mackenzie said, when they considered that nearly half of the questions on the Attitudes Toward Seeking Professional Psychological Help Scale address psychotherapy or discussing problems with a mental health provider.

"These changing attitudes mirror the decrease in utilization of psychotherapy," he said.

Psychotherapy use in the United States fell from 71% in 1987 to 43% in 2007, according to the Medical Expenditure Panel Survey. During the same period, the nation's rate of antidepressant use more than doubled.

Dr. Mackenzie said efforts to remove the stigma of mental illness included "the medicalization of depression."

In addition, direct-to-consumer advertising of prescription medications by drug makers increased in the United States after a 1997 change in guidelines by the US Food and Drug Administration.

"The initial goal to medicalize mental illness was well intentioned, but maybe it has had some negative effects," he said, referring to the decrease in positive attitudes toward specialty mental health care. "We need to look at what this means for our field 10 or 20 years from now."

Coordinated Effort Needed

Commenting on the study for Medscape Medical News, Aaron Heller, PhD, a postdoctoral fellow at the Sachler Institute for Developmental Psychology at Cornell Medical School, New York City, said he did not believe that "emphasizing that mental illness is biologically based is necessarily a bad thing. But we need further education of the public that there are many ways to change the brain."

"It will take a coordinated effort between psychologists, psychiatrists, and pharma to cause a change in attitudes such that both medication and psychotherapy can have direct effects on the brain," Dr. Heller, who was not involved with the study, added.

The study findings cannot be generalized to Canada or other countries that do not allow direct-to-consumer pharmaceutical advertising, Dr. Mackenzie said.

Insurance reimbursement patterns in the United States may be another reason college students here feel increasingly negative toward seeking specialty mental health services, he said.

A grant from the Manitoba Health Research Council supported the research. Dr. Mackenzie and Dr. Heller report no relevant financial relationships.

Anxiety and Depression Association of America (ADAA) Conference 2014. Abstract 440R. Presented March 29, 2014.

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