The emotional impact of serious illness in families is recognised. To enhance well-being in families living we must understand how distress is experienced within families; from this, evidenced-based systemic distress interventions can be derived. However, the success of systemic intervention programmes is reliant on whether families will seek help (or not) for distress. This PhD by publication explores emotional distress and help-seeking in families living with advanced cancer. Papers one and two used systematic review techniques. Paper one evidenced distress as a systemic construct and proposes the tiered model of distress to convey current understandings. Paper two offers the attaining normality model to convey why some people seek help for distress to achieve a new normality whereas some choose not to seek help to maintain normality. Together, these papers evidence gaps in systemic understandings of distress and help-seeking; from this an exploratory cross-sectional multiple case study of families was proposed. Papers three and four provided methodological underpinning to this research through the development of the DESCARTE model: The Design of Case Study Research in Healthcare (paper three) used in the case study design; paper four reflects on multi-perspective interviewing methods used. Distress and help-seeking are conceived as systemic relational phenomena, occurring within the family system and arising from relational interaction with healthcare. Distress is conveyed through four themes: interdependent distress, living in uncertainty, unnecessary distress and oscillatory distress; from this, possible systemic intervention designs are offered (paper five). Non-help-seeking for distress was the predominant response in families. The mutuality model of help-seeking is proposed to synthesise current understandings (paper six). Families describe how healthcare interactions cause unnecessary distress and shapes families’ help-seeking behaviours. Findings indicate significant gaps between the rhetoric of palliative care policy and families’ experience. To improve families’ wellbeing, relational care must be embedded in policy and practice.

The aim of this thesis is to investigate the proposition that group members use help-seeking as a strategic tool for managing and enhancing the ingroup’s image in the eyes of outgroups. The theoretical introduction outlines and assesses the history of helping-transaction research, beginning with the rich and multi-faceted work carried out by anthropologists and sociologists, before considering how social psychology has addressed this topic. The conclusion from this assessment is that the academic contribution of much of the social psychological helping-transaction research from the 1960s onwards was limited, due to its failure to address: i) the relevance of social groups, and ii) the idea that engagement in helping transactions can be motivated by desires to achieve underlying goals that relate to personal improvement or gain. Although more recent social psychological work investigated these issues, they remain under-studied. Attempting to address these neglected areas, this thesis adopts a social identity perspective, and conceptualises help-seeking as an image-management strategy. This concept is investigated in the context of a specific phenomenon with the potential to threaten the group’s image: a salient meta-stereotype. Meta-stereotypes are the stereotypes we believe to be held about our group by outgroups, and are context-dependent and often negative in valence. The prediction is thus made that group members will utilize the act of help-seeking strategically, to attempt to challenge salient negative meta-stereotypes. This is predicted to occur independently of levels of material need.This hypothesis is tested across seven experiments. Study 1 provides initial exploration of the concept, and suggests that the threat associated with help-seeking depends on how participants categorize themselves (and thus the help-giver). Studies 2 and 3 provide the first explicit manipulations of meta-stereotype salience in the thesis. Study 2 reveals that encouraging female participants to consider the idea that males perceive females as dependent leads to higher levels of perceived meta-stereotype unfairness than a purely interpersonal context, and that these perceptions of unfairness lead to reduced help-seeking from the outgroup. Study 3 strengthens this finding by shifting to an alternative identity (nationality: Scottish vs. English). It shows that, for participants who act strongly as Scots during the study, being encouraged to consider the idea that the English perceive the Scots as handout-dependent leads to less outgroup help-seeking than either an interpersonal context or an intergroup context without a salient meta-stereotype. This suggests salient meta-stereotypes have effects on help-seeking beyond those produced by a simple intergroup context. Study 4 shows these help-seeking-related effects can be obtained via a more naturalistic meta-stereotype manipulation, and also examines the relevance of the helpers’ group membership. Finally, Studies 5, 6 and 7 provide a more in-depth analysis of the key concept of strategy. Together, these last three studies show group members take heed of the contents of salient meta-stereotypes, and tailor their strategic stereotype-challenging behaviours depending on these specific contents. Moreover, these studies indicate that the nature of the meta-stereotype contents can sometimes increase participants’ help-seeking. The General Discussion summarises the thesis’ main findings and considers their contribution to the help-seeking literature and the real world.

Bakgrund: Postpartumdepression drabbar mellan 8-15 procent av kvinnor som föder barn. Depressionen bryter oftast ut några veckor efter förlossningen och kan vara upp till ett år eller mer och innebär ett stort lidande för den som drabbas. Studier visar att en stor del av de som drabbas inte söker hjälp, vilket visar på behovet av att sjuksköterskan fångar upp dessa kvinnor för att tidigt erbjuda stöd och behandling. Syfte: Syftet med litteraturöversikten var att undersöka vilka barriärer kvinnor drabbade av postpartumdepression upplever för att söka hjälp. Metodbeskrivning: Allmän litteraturöversikt valdes som metod, tio kvalitativa studier valdes utifrån databaserna PubMed och CINAHL. Artiklarna kvalitetgranskades utifrån en kvalitetsmall. Tre kategorier utformades därefter av den analyserade datan. Resultat: De kategorier som identifierades som barriärer var; kvinnorna själva, familj och omgivning samt sjukvården. Det identifierades en stor okunskap om postpartumdepression bland de deltagande kvinnorna, vilket ledde till att de normaliserade sina symtom och avvaktade med att söka hjälp. Rädslan för att bli stigmatiserade och att uppfattas som dåliga mammor var ytterligare en barriär. Bristande stöd från sjukvården framkom som ytterligare barriärer. Slutsats: Kvinnor upplever ett stigma kopplat till psykisk ohälsa och moderskap, vilket leder till att de inte söker hjälp. En ofta upplevd oförståelse inför sina symtom leder till att kvinnor normaliserar dem. En stöttande sjukvård är av största vikt, sjuksköterskans arbete kan bidra till att bryta stigmat och skapa en trygg och fördomsfri miljö där kvinnor kan öppna upp sig. / Background: Postpartum depression affects around 8-15 percent of women who have given birth. Symptoms present within a few weeks and can last upwards of a year; and cause a great deal of suffering to the women experiencing it. Evidence suggests women do not seek help for their depressive symptoms, which highlights the need of nurses to identify symptoms and offer treatment and support. Aim: The aim of this literature review is to examine the experienced barriers among women to seek help for postpartum depression. Method: The studies analysed in this literature review were chosen from the databases PubMed and CINAHL. Ten studies were included. Quality of the articles was identified using a criteria and three categories were found within the findings. Results: The three categories concerned the women, their surrounding and the health care as barriers. Stigmatisations attached to mental healt issues and the ‘ideal’ image of motherhood created a major barrier to seek help. Women experienced a lack of knowledge and understanding of PPD, they often normalised the symptoms and explained them with external factors. A lack of support from health care also posed as barriers when seeking help. Conclusion: Women experience numerous stigmatisations related to mental health issues and the ‘ideal’ image of motherhood, which figured as a major barrier to seek help. This study reiterates the importance of having supportive health care; with the nurse playing an important role in breaking this stigma and creating a safe environment for women to share their experiences.

Previous research on marital help-seeking has often focused on formal approaches such as marital therapy or relationship education and there is a greater need to understand married individual's informal help-seeking behaviors. This study explores both formal and informal help-seeking behavior using a national sample of 745 participants who have thought about divorce within the past 6-months. Findings indicate these participants more often engaged in informal help-seeking approaches to repair their marriage. Of those sampled, only 25% engaged in marital therapy together and only 9% engaged in a marriage strengthening class while over 30% read a relationship themed self-help book or visited a website as a form of repair-behavior. A series of logistic regressions indicate there are no statistically significant differences in help-seeking behavior by gender while those that were highly religious and had more serious thoughts of divorce were more likely to engage in all forms of help-seeking. A latent class analysis was conducted to determine if there are common patterns in help-seeking behavior. Results indicate there are 4 distinct types of help-seekers: Highly Engaged (5%), Private Information Gatherers (7%), Private Seekers (43%), and Minimally Engaged (45%). Follow up analyses indicate having higher levels of religiosity or having more serious thoughts of divorce were both associated with a greater likelihood of being in one of the three more engaged classes compared to the minimally engaged class. Results demonstrate the need to place more emphasis on informal help-seeking approaches, private repair-behaviors, and to consider common patterns in help-seeking behavior.

The population of Africans in the United States is growing, yet little is known about the impact of migration on the attitudes of African immigrants toward suicide, mental health, and helpseeking behavior. Migration entails movement from one cultural environment to another, and the process requires adaptation to the host country. According to Ecological Theory, interactions between the societal structures, values, and beliefs of the host country, cultural values from the country of origin, and individual-level characteristics may affect mental health-related attitudes and behaviors. As such, the current study used mixed methods, administered via online survey, to investigate socio-cultural predictors of attitudes toward suicide, mental health, and treatment seeking among African immigrants in the United States. In the current study the responses of 227 participants were used for qualitative analyses, and responses from 168 participants were used for quantitative analyses. Qualitative results indicated overall negative attitudes towards suicide and positive attitudes towards suicide prevention. Perceived culture-specific causes of suicide included acculturation difficulties, immigration stress, social causes such as home sickness discrimination, and racism, financial causes such as responsibility to kin in Africa, spiritual causes, and deportation risk. Results from quantitative analyses indicated that identification with African values and behaviors were related to lower levels of anxiety, depression, stress, and culture oriented psychological distress. Higher levels of spirituality and religiousness were associated with a negative attitude toward suicide. Implications for population based suicide prevention efforts for African immigrants and for mental health professionals working with African immigrants are discussed.

La recherche d’aide est une stratégie qui peut améliorer l’apprentissage et la réussite scolaire. Malgré ce constat, la littérature montre que les étudiants ou élèves décident fréquemment de ne pas rechercher de l’aide. Par ailleurs, dans le domaine de l’aéronautique, peu d’études ont été consacrées à la formation des contrôleurs aériens, qui jouent un rôle central dans le système de régulation du trafic aérien. Étant donné que la performance humaine est classiquement considérée comme un facteur qui contribue à la majorité des incidents et accidents aériens, l’enjeu de ces formations est majeur. L’objectif de cette thèse est double: au plan général, comprendre pourquoi les étudiants décident de ne pas rechercher de l’aide alors que la tâche à réaliser n’est pas à leur portée. Cela relève-t-il d’une décision rationnelle? Quels sont les coûts impliqués? Au plan particulier, vérifier si ce problème existe aussi dans l’environnement d’apprentissage des contrôleurs aériens et si les mêmes conclusions concernant la décision de rechercher ou non de l’aide peuvent être tirées. En ayant pour base un modèle rationnel de prise de décision, dans lequel la décision est une fonction des coûts, de la probabilité et des bénéfices, quatre expériences ont été menées: trois dont les participants étaient des étudiants universitaires et une avec les élèves contrôleurs aériens. Les résultats montrent que les étudiants hésitent à demander de l’aide quand elle est objectivement coûteuse; que le temps consommé en l’utilisant n’est pas considéré comme un coût; et que les étudiants sont prêts à demander de l’aide même quand elle n’est pas assurément utile. En outre, il y a un coût social impliqué dans la décision de rechercher de l’aide: la présence d’un expert baisse les taux de recherche d’aide, notamment quand la tâche est considérée comme facile. Les données de la quatrième expérience suggèrent que le coût social n’impacte pas la décision des élèves contrôleurs d’utiliser les aides. / Learners who encounter difficulties can improve learning and achievement by seeking help. However, literature shows that students frequently decide to not seek help. In aeronautics domain, few studies were dedicated to the training of air traffic controllers, who play an important role in the air traffic regulation system. Given that the human performance is traditionally considered a factor that contributes to the majority of incidents and accidents in aviation, the challenge of their training is greater. This thesis has two goals: generally, understand why students decide not to seek help while the task they have to realize is beyond their reach. Is this a rational decision? What are the costs involved? Specifically, to verify if this issue also exists in the context of air traffic controller training and if we find the same conclusions about help-seeking decision. Based on a rational decision model, where the decision is a function of costs, expectancies and benefits, four experiences were conducted: three of them in a general context, having university students as participants, and an experience with air traffic controllers’ students. Results show that students hesitate to seek help when it is objectively costly; the time consumed to seek help is not considered as a cost; and that students are ready to seek help even when its utility is not assured. Besides, there is a social cost implicated in the decision to seek help: the presence of an expert reduces the levels of help-seeking, particularly when the task is considered easy. The results of the fourth study suggest that the social cost adversely do not have an effect in the decision of air traffic controller students of using all help tools, but the difficulty of the exercise may affect the decision of seeking some kinds of help.

Masculinity research suggests help-seeking attitudes towards mental health concerns conflict with socialized masculine norms such as emotional control and self-reliance (Addis & Mahalik, 2003; Heath, Brenner, Vogel, Lannin, & Strass, 2017). As psychologists continue to find ways to reach out to men, exercise intervention may be the catalyst for men to seek out psychological services. More specifically, boxing training has been shown to increase the sense of self-confidence and character development (Shultz, Stoner, Lambrick, & Lane, 2014; Sokol, 2004). In this study, 24 men engaged in a six-session boxing training program to examine the impact high-intensity exercise has on psychological help-seeking attitudes and psychological distress. Participants reported lower psychological distress, an increase in health behaviors, and high levels of exercise self-efficacy throughout the intervention. Additionally, participants who reported greater adherence to traditional masculine norms endorsed greater psychological distress compared to participants reporting lower adherence to masculine norms. Help-seeking attitudes towards psychological services did not change throughout the boxing program, suggesting men may gain the psychological benefits they seek directly from action-oriented activities.

The internalization of stigmatizing beliefs is influential on the attitudes a person holds toward seeking help because it leads to harm on one’s self-esteem and concept of self (Corrigan, 2004). The Model of Self-Stigma (Corrigan, Watson, & Barr, 2006) outlines the process of how self-stigma develops and highlights the essential role agreement with negative stereotypes has on the development of self-stigma. Research on the stereotypes relevant to African Americans is limited, and no scale exists to measure stereotype endorsement specific to this population. The current study investigated the relevant beliefs held among African Americans toward psychological help seeking and developed a scale to examine the stereotype endorsement stage of the Model of Self-Stigma. Study one involved conducting an Exploratory Factor Analysis on 228 participants and produced one single factor describing help seeking beliefs for the population. Study two involved conducting hierarchical linear regressions on 148 participants to determine whether the Psychological Help Seeking Stereotypes for African Americans (PHSSA) scale accounted for unique variance beyond existing stereotype endorsement scales developed on majority White samples. Results indicated that the PHSSA scale accounted for unique variance beyond that of the existing stereotype endorsement scales. Implications for the PHSSA scale are discussed.

<p>Abstract</p><p>Intimate partner violence (IPV) is highly prevalent in Pakistan. Social support is associated with a reduced risk for violence and adverse mental health. The purpose of this study was to investigate the association between social support and the occurrence of IPV and adverse mental health among Pakistani women exposed to IPV, along with exploring help-seeking behaviour using qualitative interviews. Data from a cross-sectional survey of 759 women, aged 25–60, were analyzed using logistic regression. The results demonstrated that informal social support was associated with fewer occurrences of all forms of IPV and less likelihood of adverse mental health when exposed to psychological violence, whereas formal social support was associated with more occurrences of all forms of IPV and more likelihood of adverse mental health when exposed to psychological violence. The qualitative result showed that fear of social stigma and low autonomy were, among others, obstacles for seeking help. Suggestions for future interventions include strengthening informal social networks and expanding formal resources, as well as raising awareness of IPV in order to address the issue.</p><p><strong> </strong></p> / This thesis was made possible by a Minor Field Study grant from the Swedish International Developmental Agency (SIDA) distributed by the department of Psychology at Stockholm University and we would like to express our gratitude for assisting us financially. / PhD project by Tazeen Saeed Ali, School of Nursing, Aga Khan University, called, “Living with violence in the home - a normal part of Pakistani women's life or a serious transgression of human rights.”

Thesis (M.S.)--University of Delaware, 2005. / Principal faculty advisor: Ruth E. Fleury-Steiner, Dept. of Individual & Family Studies. Includes bibliographical references.