How can service use for mental illness be improved? A quasi-experimental online study on the potential for change of personal stigma and intermediary variables in the context of service use

在我们正在进行的DFG资助的项目中，我们正在进行一项前瞻性研究，涉及个人态度，即将到来的自我污名和目前未经治疗的社区样本中精神疾病的服务使用。我们能够重建一个过程，从症状的感知开始，然后是自我认同为精神病患者，这导致了治疗的需要以及寻求帮助的意图，最后是服务的使用。寻求帮助的意图是最强的预测实际寻求帮助，而污名化的态度主要与自我认同为精神病患者。由于这些双边关系，自我认同被确定为服务使用过程中的一个敏感因素。其他重要的中介变量包括心理健康素养、自我效能、因果信念、主观疾病分类概念以及既往治疗经验和当前症状严重程度。在这个后续项目中，我们的目标是扩大我们原来的耻辱作为一个障碍，以服务使用的模型，将这些中介过程变量，并系统地测试它们的效果和相互依赖的服务使用过程。自我调节的常识模式提供了相应的理论框架，该模式将健康问题的一般应对过程概念化，因此非常适用于我们的目标群体，即目前未经治疗的精神障碍患者。在方法上，中介变量，这可能会自适应地影响自我认同和服务使用过程中，将被操纵的多因素随机准实验在线研究。与当前研究相似，将在6个月内进行两次随访评估。潜在地，我们的研究提供了有希望的影响研究和实践：首先，合并的理论方法的实证检验有关耻辱（包括目前的项目），精神疾病的概念化（在CSM）和服务使用的阶段，所有三个过程以及潜在的出现将被仔细检查。其次，我们的在线研究结果为基于证据的精神疾病在线干预措施的设计和评估提供了起点。由于越来越多的折衷、非科学和主要是商业性的提议，这一点至关重要。

In our ongoing DFG-funded project, we are conducting a prospective study concerning personal attitudes, impending self-stigma and service use for mental illness in a currently untreated community sample. We were able to reconstruct a process that begins with the perception of symptoms, followed by self-identification as mentally ill, which leads to the need for treatment as well as the intention to seek help, and finally service use. The intention to seek help was the strongest predictor of actual help seeking, while stigmatising attitudes were mainly associated with self-identification as mentally ill. Due to these bilateral associations, self-identification was identified as a sensitive element in the service use process. Other important intermediary variables include mental health literacy, self-efficacy, causal beliefs, and subjective nosological concept as well as prior treatment experience and current symptom severity. In this follow-up project, we aim to expand our original model of stigma as a barrier to service use to incorporate these intermediary process variables and systematically test their effect and interdependence in the service use process. A corresponding theoretical framework is provided by the Common Sense Model of Self-Regulation (CSM) which conceptualises the general coping process with health problems and which is therefore highly applicable to our target group of civilians with currently untreated mental disorders. Methodologically, the intermediary variables, which could adaptively affect self-identification and the service use process, will be manipulated in a multi-factorial randomized quasi-experimental online study. Similar to the current study, there will be two follow-up assessments over a period of 6 months. Potentially, our study offers promising implications for research and practice: Firstly, the empirical examination of the merging of theoretical approaches regarding stigma (including the current project), the conceptualisation of mental illness (in the CSM) and stages of service use, all three processes as well as a potential emergence will be closely examined. Secondly, the results of our online study provide starting points for evidence-based design and evaluation of online interventions for mental illness. Because of the growing body of eclectic, non-scientific and primarily commercial offers, this is of paramount importance.