Effects of a unit of instruction in mental health on rural adolescents' conceptions of mental illness and attitudes about seeking help

Adolescence, Summer, 1998 by Irvin G. Esters, Philip G. Cooker, Richard F. Ittenbach

According to recent estimates of the prevalence of mental disorders and data collected on the use of mental health services, it is clear that resources designed to assist those in need of care are underutilized (Horwitz, 1987). One factor thought to contribute to the underutilization of mental health services, especially among rural Americans, is the stigma attached to mental illness and the associated help-seeking process.

Wodarski (1983) has suggested that the very act of seeking help, whether a diagnosis of mental illness is substantiated or not, may initiate social bias directed at the help seeker. Rural Americans, perhaps more so than other groups, are susceptible to the effects of stigma associated with mental illness. Certain characteristics of rural residents, such as their high regard for autonomy and self-help, are reportedly related to the propagation of stigma (Kelleher, Taylor, & Rickert, 1992). Stigma tolerance has been cited as a mediator of help-seeking behavior, which perhaps explains why proportionately fewer rural residents use mental health services than do urban residents (Flaskerud & Kviz, 1982). It would seem that a logical step in removing the stigma, and thus in removing an obstacle to service delivery, is to promote positive attitudes about seeking psychological help and to foster a less stereotypical and myth-laden view of mental illness (M. O. Wagenfeld, personal correspondence, 1994).

Napoletano (1981) has indicated that five factors influence attitudes about mental illness: classroom instruction, age, contact with mental patients, fear reduction, and length of practicum in mental health. Adolescence is a prime time to influence attitudes related to mental illness and help seeking, especially since few adolescents perceive therapeutic methods as an option when faced with emotional problems. Changing attitudes is particularly important because behavioral problems have replaced infectious disease as the major cause of morbidity and mortality among adolescents. Several researchers have noted that depression, substance abuse, physical and sexual abuse, and teenage pregnancy are the "new morbidities of youth" (Battaglia, Coverdale, & Bushong, 1990; Blum, 1987; Offer & Schonert-Reichl, 1992).

The purpose of the present study was to determine if a unit of instruction designed to change conceptions of mental illness and attitudes about seeking professional help was effective. The changes facilitated by the intervention were also tested for durability over time.

METHOD

Participants

Forty adolescents, 13 to 17 years of age (M = 14.7 years), participated in this study. The school from which participants were recruited was located in a rural area near a northern Mississippi township with a population of less than 700. Of the families living within the school district, 14.17% had incomes below the poverty level.

All students in the ninth grade who were enrolled in health classes, who had parents' or guardians' permission to participate, who themselves agreed to take part, and who were present during the entire treatment period were included in the study. Twenty-five (62.5%) were female and 15 (37.5%) were male. They were placed in either the treatment group or the control group, based on their class assignments.

Measures

The first dependent variable, students' conceptions of mental illness, was measured using the Opinions about Mental Illness Questionnaire (OMI; Cohen & Struening, 1962). The OMI was developed to identify opinions about the cause, treatment, and prognosis of mental illness. The instrument contains 51 items, which are scored on a 6-point Likert scale, ranging from strongly disagree (0) to strongly agree (5). Scores derived from Factor A, Factor D, and Factor E were used exclusively in the analysis, as several sources have reported poor internal consistency for the other factors. Factor A is most accurately defined as authoritarianism, and measures opinions about the mentally ill as an inferior class requiring coercive handling. Factor D, identified as social restrictiveness, measures the opinion that the mentally ill are dangerous and should be controlled. Factor E, identified as interpersonal etiology, measures the opinion that mental illness is caused by interpersonal experiences, especially parental deprivation during childhood. The raw scores were used for comparison purposes in the present study.

The second dependent variable, students' attitudes toward seeking psychological help, was measured using the Fischer-Turner Pro-Con Attitude Scale (FTAS; Fischer & Turner, 1970). The FTAS consists of 29 Likert-type items scored on a 4-point scale, ranging from disagree (0) to agree (3). Although four factors have been identified, full-scale scores were used in the present analyses.

Participants were also presented with an open-ended question asking them if and from whom they had sought help for an emotional problem.

Procedure

Permission to conduct the study was obtained from the principal of the school, the health teacher, and the superintendent of the district. Students who had obtained parental permission attended their regularly scheduled health classes, where they completed all measures. Both classes (treatment group and control group) met for a total of 270 minutes during the week.