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，我们正在进行一项关于个人态度、即将到来的自我耻辱和精神疾病服务使用的前瞻性研究，研究对象是目前未接受治疗的社区样本。我们能够重建一个从感知症状开始，然后自我确认为精神病患者的过程，这导致需要治疗以及寻求帮助的意图，最后是服务使用。寻求帮助的意图是实际寻求帮助的最强预测因素，而污名化态度主要与自我认同为精神疾病有关。由于这些双边联系，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、主观病因学概念以及先前的治疗经验和当前症状严重程度。在这个后续项目中，我们的目标是扩展我们最初的污名作为服务使用障碍的模型，以纳入这些中介过程变量，并系统地测试它们在服务使用过程中的效果和相互依赖。自我管理常识模式(CSM)提供了相应的理论框架，它概念化了应对健康问题的一般过程，因此非常适用于我们目前未接受治疗的精神障碍平民目标群体。在方法上，可以自适应地影响自我认同和服务使用过程的中介变量将被操纵在多因素随机准实验在线研究中。与目前的研究类似，将在6个月内进行两次后续评估。我们的研究潜在地为研究和实践提供了有希望的启示：首先，关于污名(包括当前的项目)、精神疾病的概念化(在CSM中)和服务使用阶段的理论方法的融合的实证检验，所有这三个过程以及潜在的涌现将被密切检查。其次，我们的在线研究结果为精神疾病在线干预的循证设计和评估提供了起点。由于折衷的、非科学的、主要是商业的报价越来越多，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.