Year of Award

2025

Document Type

Dissertation

Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Duncan Campbell

Commitee Members

Christine Fiore, Rachel Severson, Allen Szalda-Petree, Christina Yoshimura

Abstract

Stigma is often cited as a significant barrier to mental health care (e.g., Andrade et al., 2014), but less is known about the impact of stigma on treatment engagement over time. The literature often calls for prospective studies (e.g., Clement et al., 2015). Additionally, little is known about label avoidance and its relationship to the other components of stigma, public and self-stigma. This study examined stigma’s association with mental health treatment engagement over time and the relationship between public stigma, self-stigma, and label avoidance. Specifically, the study assessed participants’ responses to stigma and related covariate measures. Approximately 5 weeks later, treatment engagement and treatment consideration were assessed. Logistic regressions assessing the impact of stigma components on treatment engagement and consideration showed several significant findings. Higher levels of public stigma were predictive of lower treatment engagement. This finding remained consistent in a sample of individuals indicating at least moderate levels of distress. Higher levels of self-stigma predicted greater treatment consideration and higher levels of label avoidance showed lower levels of treatment consideration. The truncated sample of moderately distressed participants showed a similar result for label avoidance. Serial mediation and moderation models of stigma components impacting both treatment engagement and consideration were not significant. The truncated sample showed one significant interaction effect in the moderation model. This indicated that higher levels of public stigma and label avoidance were present with lower levels of treatment engagement. Implications for future research and interventions are discussed. Overall, the study shows the need for prospective studies examining the complex relationships between stigma and the behavior of interest, treatment engagement. Additionally, more research on label avoidance is warranted.

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© Copyright 2025 Kali Diane Strickland