Research has extensively documented the mental health disparities that exist for ethnic and racial minorities living in the United States. With respect to Latinos, such disparities are marked by less access to care and poorer quality of mental health treatment. Studies on Latino mental health have found differences in mental health service utilization among ethnic subgroups and among different generations of Latinos. However, empirical data examining specific attitudes and barriers to mental health treatment among different generations of Latinos are limited. This study explored the relationships between Latino generational status, mental health service utilization, psychological distress, and barriers to mental health treatment. An online survey (N = 218) included samples of first-generation (n = 67), second-generation (n = 86), and third-generation or beyond Latinos (n = 65). Results indicated first-generation Latinos had the lowest rate of mental health service utilization and reported greater linguistic and structural knowledge barriers, however, they had lower perceived social stigma of mental health services when age at migration was considered. Implications of these findings for research, mental health service providers and mental health policy are discussed.

The disproportionate amount of mentally ill offenders in the United States’ prison system and the lack of correctional treatment they receive have been an under-addressed problems for decades. This goal of this study was to examine the various individual and institutional barriers that hinder mentally ill offenders from accessing and participating in mental health treatment services. These barriers are analyzed using an expectancy theory framework. Specifically, the factors are fit into the Valence – Instrumentality – Expectancy model in an attempt to predict the impact that these barriers have on the number of mental health contact hours the offender engages in. Data for this analysis was obtained from 165 offenders with mental illness incarcerated in the Illinois Department of Corrections. Results indicate that offenders who experience fewer individual barriers (stigma and skepticism) and institutional barriers (quality of provider) are more likely to engage in more mental health services hours. Further, expectancy variables were expected to have the strongest impact on service engagement, but this hypothesis was not supported. Instead, valence variables had the strongest impact. But, the expectancy theory model with all components included is significant and useful to examine correctional mental health treatment utilization. This study is the first to apply expectancy theory to correctional mental health, and illuminates areas of policy improvements in this area.

Military service members are a subpopulation of the postsecondary student body. Many service members report symptoms of depression and posttraumatic stress disorder (PTSD). Yet, practical and stigma-related barriers prevent these service members from seeking treatment, often when treatment services are available as part of post-enlistment benefits. Using a variety of surveys, the present thesis assessed the demographics, self-reported symptoms of PTSD and depression, perceptions of treatment, and treatment utilization among military-affiliated students on a postsecondary campus. Correlational analyses revealed that severity of PTSD and depression symptoms were positively correlated with overall treatment utilization. However, practical and stigma-related barriers were not significantly associated with treatment utilization. Multiple regression analyses revealed that stigma-related and practical barriers did not moderate the relationship between symptoms of PTSD or depressive symptoms and treatment utilization. Post-hoc analyses showed a positive correlation between reported practical barriers and on-campus treatment utilization, and also revealed that on-campus treatment utilization was positively correlated with overall treatment utilization and positively correlated with utilization of community-based health services. The impact of these findings is discussed.

Substance use disorders (SUDs) are often comorbid with other psychopathology such as mood disorders, anxiety disorders, and personality disorders. While some research suggests individuals with comorbid psychopathology are more likely to seek substance use treatment than those with independent disorders, other studies have also shown many individuals with dual diagnoses still never seek treatment. Moreover, few studies have tried to elucidate the underlying structure of SUD treatment rejection, and instead examined it in more simplistic terms. In addition, studies have tended to examine the impact of individual disorders on treatment rejection, but have not incorporated an empirically supported approach to conceptualizing psychopathology in terms of comorbidity between broad latent dimensions referred to as internalizing (e.g., depression, anxiety) and externalizing (e.g., antisocial personality disorder, polysubstance use) psychopathology. Modeling psychopathology in terms of internalizing and externalizing psychopathology is becoming a prominent approach to understanding mental disorders, yet little research to date has investigated the effects these broad dimensions have on SUD treatment rejection. The current study utilized latent variable modeling techniques to (1) determine the latent structure of SUD treatment rejection in a large U.S. sample, and investigate whether treatment rejection is a multidimensional construct; and (2), to explore the ability of internalizing psychopathology, externalizing psychopathology, and personality pathology to predict the SUD treatment rejection factor(s). The current study relied on use of a general population sample of 43,093 individuals from the first wave of National Institute on Alcohol Abuse and Alcoholism's National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study. Support was found for the hypothesis that SUD treatment rejection would be a multidimensional construct.  Exploratory structural equation modeling indicated a three-factor model best fit the data. Operational definitions and clinical implications of these three treatment rejection factors ("Objective barriers," "Psychological barriers," and "Self-focused barriers") are discussed. Among internalizing psychopathology, externalizing psychopathology, and personality pathology, structural equation modeling identified internalizing psychopathology as the most robust predictor of these three factors for alcohol treatment rejection (n = 1063), indicating endorsement of treatment barriers increased as levels of internalizing psychopathology increased. This pattern also held true for externalizing psychopathology, while personality pathology only negatively predicted objective treatment barriers.  For drug treatment rejection (n = 562), only internalizing psychopathology significantly predicted the treatment rejection factors, indicating treatment endorsement of drug treatment barriers increased as levels of internalizing psychopathology increased. Implications of these findings and directions for future research are discussed.

abstract: Approximately one-third of Iraq and Afghanistan veterans develop mental health problems, yet only 35-40% of those with mental disorders are seeking mental healthcare (Hoge, et al., 2004; Vogt, 2011). Military spouses may be an important resource for facilitating treatment seeking (Warner, et al., 2008), especially if service member mental health issues are impacting the marriage. Military spouses might be hesitant to encourage service member help-seeking, however, due to perceived threat of adverse military career consequences. For this study, 62 military wives completed an online survey. As part of the survey, participants were randomly assigned to one of four vignettes containing a description of a hypothetical military husband with mental health symptoms. Each vignette presented different combinations of marital conflict (high versus low) and service member concerns about adverse career consequences (high versus low). Wives rated on a five-point scale how likely they were to encourage the hypothetical military husband to seek help. It was hypothesized that spouses would be more willing to encourage help-seeking when concerns about adverse military career consequences were low and marital distress was high. No main effects or interaction effect were found for marriage and career. Perceived stigma about seeking mental health treatment in the military, psychological identification as a military spouse, and experience and familiarity with military mental healthcare policies failed to moderate the relationship between marital conflict, career concerns, and encouragement of help-seeking. Correlational analyses revealed that (1) greater experience with military mental healthcare (first- or secondhand), and (2) greater perceptions of stigma regarding seeking mental healthcare in the military each were associated with decreased perceptions of military supportiveness of mental healthcare. Therefore, although the experimental manipulation in this study did not lead to differences in military spouses' encouragement of a hypothetical military service member to seek mental health services, other findings based on participants' actual experiences suggest that experiences with military mental healthcare may generate or reinforce negative perceptions of military mental healthcare. Altering actual experiences with military mental healthcare, in addition to perceptions of stigma, may be a useful area of intervention for military service members and spouses. / Dissertation/Thesis / M.S. Psychology 2013

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Masters of Art / High rates of substance use and its associated problems afflict Cape Town, underscoring the need for easily accessible substance abuse treatment. Despite the substantial benefits for both individuals and society at large that substance abuse treatment confers, substance abusers often first have to negotiate considerable challenges in order to access treatment and accumulate these gains. That is, experiencing barriers to accessing treatment, together with the presence of socio-demographic features, rather than “need for treatment”, decides who accesses treatment. Referrals are the gateway to inpatient substance abuse treatment in the Western Cape. While several barriers to accessing treatment have been identified by prior studies, none examine these phenomena from the point of view of the agents responsible for referring substance users for treatment. Moreover, access barriers to inpatient substance abuse services are a neglected area in extant literature. To address this gap, this study explored the perceptions of referring agents‟ of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape. This enabled the researcher to compare existing access barriers to treatment as identified by prior research, to those elucidated in the study. Bronfenbrenner‟s Process-Person-Context-Time model was employed as the basis for understanding identified barriers. In accordance with the exploratory qualitative methodological framework of the study, six semi-structured individual in-depth interviews were conducted with referring agents‟ of differing professional titles who were purposefully selected and expressed a willingness to participate in the study. Interviews were audio-recorded, and transcripts were analysed and interpreted by means of Thematic Analysis. Two broad thematic categories of access barriers were identified: Person-related barriers (denial, motivation for treatment, gender considerations, disability, active TB disease, homelessness, psychiatric co-morbidity) and Context-related barriers to treatment (cultural and linguistic barriers, stigma, community beliefs about addiction and treatment, awareness of substance abuse treatment, affordability/ financial barriers, geographic locations of treatment facilities, waiting time, lack of collaboration within the treatment system, beliefs of service providers‟, lack of facilities/ resources within the treatment system, practices at inpatient facilities, referral protocol and uninformed staff). Results suggest that by targeting the aforementioned barriers, access to inpatient and outpatient treatment services can be improved, and recommendations for interventions are offered in this regard. Ethical principles such as obtaining informed consent and ensuring confidentiality were abided by throughout the study and thereafter.

Timely access to child mental health services is a widespread concern. Many children with diagnosable disorders do not receive help. Untreated disorders can cause significant child and family impairment. Barriers to treatment can impede access. Few specialists, long wait lists and clinic-based services can be problematic. Families encounter treatment barriers related to travel (i.e., time off work or school; inconvenience; financial burden), stigma, and child resistance to therapy. Alternative models of care are needed. Distance telephone treatment (e.g., Strongest Families), can bridge the access gap. There is little understanding about the participants’ experience with distance treatment. The research objectives were: 1. to establish if therapeutic alliance exists between a) a parent-coach and b) a child-coach, when distance treatment is delivered by telephone with no face-to-face contact; 2. to explore the parents’ distance experiences and opinions; 3. to develop and validate the Treatment Barrier Index (TBI) scale derived from participants’ experiences; and 4. to use the TBI to examine treatment barrier differences (and therapeutic processes) between two delivery systems (Distance vs Face-to-face). Therapeutic alliance exists between adult-coach and child-coach with distance treatment. Participants found distance treatment to be more private and felt less stigmatized because of visual anonymity, compared to their opinions of face-to-face services. The TBI results indicated fewer perceived barriers with distance treatment. A significant difference was found between delivery systems in terms of perceived barriers, therapeutic alliance and self-disclosure as a group of variables. This suggests that there may be differences in therapeutic processes between systems. Therapeutic alliance scores were enhanced with distance treatment and found to positively correlate with self-disclosure and outcome scores; suggesting that these processes are important in the context of distance intervention. Cost-effective distance systems using non-professionals may be one way to increase access to child mental health services. Although some families may prefer the physical presence of face-to-face services, others prefer distance services. The results from these studies may help to inform system design improvements aimed at increasing service access. Improving models of care to meet participants’ needs could lead to increased service utilization, ultimately improving child health outcome.