Graduation Year

2009

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Aging Studies

Major Professor

Lawrence Schonfeld, Ph.D.

Keywords

Stigma, Mental illness, Depression, Alcohol use, Elderly

Abstract

Research suggests that more than ten percent of older adults experience behavioral health problems (including mental health problems and/or substance abuse). However, very few actually receive care from a behavioral health care provider or even a primary care provider. One major barrier to accessing and receiving care is the feeling of perceived stigma commonly associated with behavioral health problems. The present study examined the relationships among attitudinal variables, feelings of stigma, and behavioral health outcomes over time in an elderly population with the secondary analysis of data collected for a previously implemented research study, the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study. The PRISM-E research project was a multisite, randomized, comparative trial examining two models of care for persons aged 65 and older with symptoms of depression, anxiety, and/or at-risk drinking.

A total of 2,022 participants over the age of 65 were included in the database. Over half of the participants indicated that they had some feelings of stigma associated with mental health and substance abuse issues. An examination of the measure used in the PRISM-E study to measure stigma revealed the presence of two factors, or components, of stigma that we labeled Perceived Stigma and Comfort Level. Statistical analyses of the data demonstrated that feelings of stigma are not constant and can indeed change over time. However, in this sample, perceived stigma was not related to behavioral health outcomes, such as a reduction in symptoms of depression, anxiety, and/or at-risk drinking. Limitations of this study include the possibility that the sample may be biased due to the fact that all participants were under the care of a primary care provider and all agreed to enter treatment for their behavioral health problem.

Implications of the findings are that it is possible to influence feelings of stigma and previous research has demonstrated that lower levels of feelings of stigma in older adults as well as other age groups may lead to improvements in accessing and engaging in behavioral health treatment.

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