Study Variables and Measurement

Demographic Variables:

Self-reported demographic information obtained included age, marital status, gender, education, employment status, income and self-reported mental health status

.

Independent variable:

This researcher utilized respondents’ self-report of their racial and ethnic minority background to measure the independent variable of race. Race is an appropriate independent variable in that it has been identified as a significant predictor of certain treatment seeking attitudes and behaviors (Snowden, 2001).

Dependent Variable (1):

‘Attitudes Toward Mental Health Services’ was assessed utilizing the Attitudes Toward Mental Health Treatment Scale (ATMHT). The ATMHT is comprised of 20 items with a four-point Likert scale, and is intended to reflect an individual’s attitude toward professional mental health treatment. For the purpose of this study, a modified version of the 29 item Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS; Fischer & Turner, 1970) was used. Despite its utility and vast usage, several conceptual and methodological concerns have been raised regarding the language and cultural appropriateness of the ATSPPHS. To address these concerns, this researcher adapted this scale to include more culturally relevant language and items. Higher scores indicate more positive attitudes about seeking mental health treatment. This scale was utilized with a racially diverse community-based sample of older adults (Conner,

2006). Preliminary reliability tests of the ATMHT have been positive, as it demonstrated high internal consistency with a Cronbach’s alpha = 0.95.

Dependent Variable (2):

‘Engagement in Mental Health Treatment’ was assessed with 3 questions. The first question asked, “At any time in the past, have you ever visited a mental health professional (psychiatrist, psychologist, social worker, mental health counselor, or primary care physician for a problem with your emotional or mental health (yes or no)?” If yes, “When was your most recent visit? Within the past month, 1-6 months ago, 7-12 months ago, more than 12 months ago.” A third question asked: “Are you currently receiving treatment for depression (yes or no)?”

Dependent Variable (3):

‘Intention to Seek Treatment for Depression’ was assessed with one item: “During the next month, I intend to speak or meet with a health professional to discuss my symptoms of depression.” Respondents indicated on a 5-point scale (extremely unlikely to extremely likely) the likelihood of engaging in this behavior.

Potential Mediator Variable (1):

‘Public stigma’ was assessed utilizing the Perceived Devaluation and Discrimination Scale (PDD; Link, 1982). This 12-item, four-point Likert scale, evaluates the extent to which a person believes that other people will devalue or discriminate against someone with a mental illness.

Higher scores indicate higher levels of public stigma. This scale was successfully utilized with a sample of older adults in a preliminary study (Conner, Koeske, & Brown, 2006). The PDD demonstrates high internal consistency with estimates ranging from .82 to .93 and demonstrates good construct and predictive validity (Link, 1982; 1989). For the current investigation, the scale was revised and items referred to having ‘had depression’ rather than ‘having been treated for a mental illness.’ The rationale for this revision suggested that views about severe mental illnesses and depression might differ and, therefore, it was necessary to distinguish between the two terms and dissociate treatment for a mental illness from the presence of depression. The psychometrics for the revised PDD scale are reported in the study results (see chapter four).

Potential Mediator Variable (2):

‘Internalized stigma’ was assessed utilizing the Internalized Stigma of Mental Illness Scale (ISMI) (Ritsher, Otilingam, & Grajales, 2003). Distinct from other stigma scales, which focus on social attitudes toward the mentally ill or perceptions of these attitudes, the ISMI focuses on the individual’s subjective experience as someone with a mental illness. The ISMI contains 29 items rated on a four-point Likert scale, and assesses alienation, stereotype endorsement, perceived discrimination, social withdrawal, and stigma resistance. Higher scores indicate higher levels of internalized stigma. This scale was successfully utilized with a sample of older adults in a preliminary study (Conner, Koeske, & Brown, 2006). The ISMI demonstrates excellent internal consistency reliability estimates ranging from .88 to .94 and demonstrates good construct and predictive validity (Corrigan, 2004; Ritsher et al., 2003). For the current investigation, the scale was revised and items referred to having ‘had depression’ rather than ‘having a mental illness.’ The rationale for this revision was that views about severe mental illnesses and depression might

differ and, therefore, it was necessary to distinguish between the two terms. The psychometrics for the revised ISMI scale are reported in the study results (see chapter four).

Clinical Characteristics:

The Patient Health Questionnaire (PHQ-9) (Kroenke, Spitzer, & Williams, 2001) was used to characterize severity of the depressive symptoms, existence of clinically significant depressive symptoms, and presence of current psychosocial impairment. The PHQ-9 has been used extensively to examine depression symptoms and has been successfully utilized with both older adult populations and African Americans (Oslin et al., 2006). Cut-points have been established that correspond to minimal (score 1-4), mild (score 5-9), moderate (score 10-14), moderately severe (score 15-19), and severe (score 20-27) symptom levels and algorithms developed to establish depressive disorder diagnoses. Anyone who received a score of 5 and above was eligible to participate in this study. Any participant who scored a 10 or above on the PHQ-9, or who requested a referral, was referred for treatment at Western Psychiatric Institute and Clinic (WPIC) or at the participant’s local community mental health center. To minimize risk of suicide, if a respondent endorsed the suicide item # 9 on the PHQ-9 (e.g., ‘thoughts of harming oneself’) the call was handed over to a trained supervisor at UCSUR who assessed the severity of the suicidal ideation, assessed imminent risks, and implemented a referral for evaluation at Western Psychiatric Institute and Clinic.