A Dissertation Entitled The Effects of Anti-Stigma Interventions in Resident Advisors’ Attitudes Toward Mental Illness By Stephanie McGuire Wise Submitted to the Graduate Faculty as a partial fulfillment of the requirements for the Doctor of Philosophy Degree in Counselor Education ______________________________________________________ Dr. John Laux, Committee Chair ______________________________________________________ Dr. Debra Harmening, Committee Member ______________________________________________________ Dr. Caroline O’Hara, Committee Member ______________________________________________________ Dr. Christopher Roseman, Committee Member ______________________________________________________ Dr. Amanda C. Bryant-Friedrich, Dean College of Graduate Studies The University of Toledo December 2016 Copyright 2016, Stephanie McGuire Wise Copyright 2016, Stephanie McGuire Wise. This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author. An Abstract of The Effects of Anti-Stigma Interventions in Resident Advisors’ Attitudes Toward Mental Illness By Stephanie McGuire Wise Submitted to the Graduate Faculty as a partial fulfillment of the requirements for the Doctor of Philosophy in Counselor Education The University of Toledo December 2016 College students with mental illness benefit from counseling services to overcome barriers to success. Resident Advisors (RAs) can refer students, but need education and training to decrease the effects of mental health stigma. The purpose of this study was to determine if anti-stigma interventions produced differences in mental health stigma in the RA population. In this study, 94 RAs participated in interventions involving education and personal testimony. Three published instruments were selected to measure mental health stigma. The Separate-Sample Pretest-Posttest Design 12c (Campbell & Stanley, 1963) was used to separate participants into two groups. Paired samples and independent samples t-tests were calculated to determine within and between group results. Results showed that public stigma and one factor of self-stigma was less from time one to time two. Effect sizes were mostly in the small to medium range. In addition, post-test scores were not sensitized by pre-test scores with any of the measures. Limitations include reliability of one of the instruments and generalizability to other populations. Implications for counseling center personnel, Residence Life staff, and university administrators are discussed as well as future directions for research. Keywords: stigma, retention, college student, resident advisor, personal testimony ii i For my husband and daughter who supported me throughout this journey. iv Acknowledgement My doctoral degree would not have been possible without the love and support of my family, friends, colleagues, and committee members. Their flexibility was essential to this pursuit. Thank you to my friends, colleagues, and classmates: your support was incredible and much appreciated. To Linda Myerholtz, who inspired me through her professionalism and dedication to the profession, you are my dearest friend. To my committee chair, Dr. John Laux, whose support and mentorship helped me see it all the way through. I could not have done this without you. To my committee: Dr. Deb Harmening, Dr. Caroline O’Hara, and Dr. Chris Roseman – your input was invaluable and helped me develop into a better researcher and better writer. I hope to partner with you again. And to my husband, Patrick, and daughter, Aralyn – I love you more than words can say. Finally, I want to thank the many nurses, medical staff, and especially my team of physicians who saw me through the most challenging battle of my life. I literally would not be here without you. God Bless. v Contents Abstract iii Acknowledgement v Contents vi List of Tables xii List of Figures xiii List of Abbreviations xiv 1 Introduction 1 1.1 Introduction ……………………………………………………………….1 1.2 Statement of the Problem………………………………………………….1 1.2.1 The Stigma of Mental Illness………………...……………………2 1.2.2 Perceived Public Stigma…………………………………………..3 1.2.3 Self-Stigma…………………………………..……………………4 1.2.4 How Stigma Affects Personal Lives………………………………6 1.2.5 How Stigma Affects Opportunities……………………………….6 1.2.6 Mental Health in the College Population………………………….7 1.3 Background of the Problem……………………………………...………..9 1.3.1 Utilization of Counseling Services………………………………10 1.3.2 The Impact of Mental Health Stigma on Help-Seeking Behavior.13 1.3.3 Retention…………………………………………………………14 v i 1.3.4 The Effects of Stigma on the Community……………………….18 1.3.5 The Impact of Training…………………………………………..19 1.4 Purpose of the Study……………………………………………………..20 1.5 Research Questions………………………………………………………20 1.6 Significance of the Study……………………...…………………………21 1.7 Definition of Terms………………………………………………………22 1.8 Organization of Chapters……….………………………………………..24 1.9 Summary…………………………………………………………………24 2 Literature Review 26 2.1 Introduction………………………………………………………………26 2.2 Mental Health Issues on College Campuses……………………………..26 2.2.1 Explanations for the Underutilization of Counseling Services…..31 2.2.2 Retention and Mental Health…………………………………….34 2.3 Stigma……………………………………………………………………38 2.3.1 Theories of Stigma Development………………………………..42 2.3.1.1 Social Cognitive Theory…………………………………43 2.3.1.2 Attribution Theory……………………………………….44 2.3.2 How Stigma Affects Opportunities……………………….……..47 2.3.3 How Stigma Affects Personal Lives………………………….….49 2.3.4 Perceived Public Stigma…………………………………………50 2.3.5 Self-Stigma………………………………………………………51 2.4 Resident Advisors……………………………………………………….54 2.4.1 Training Modules………………………………………………..56 vi i 2.5 Methods to Decrease Stigma…………………………………………….57 2.5.1 Education………………………….……………………………..59 2.5.2 Experiential Learning…………………………………….………62 2.5.3 Protest……………………………………………………………63 2.5.4 Personal Contact…………………………………………………64 2.5.4.1 In Our Own Voice………………………………………..68 2.5.5 Decreasing Self-Stigma…………….……………………………68 2.6 Measures of Public, Perceived Public, and Self-Stigma…………………70 2.6.1 Measures of Public Stigma………………………………………70 2.6.1.1 Reported and Intended Behaviour Scale…………………71 2.6.1.2 Attribution Questionnaire………………………………..72 2.6.1.3 Opinions About Mental Illness Scale……………………73 2.6.1.4 The Community Mental Health Ideology Scale…………74 2.6.1.5 Community Attitudes Toward the Mentally Ill………….75 2.6.2 Measures of Perceived Public Stigma…………………………...80 2.6.2.1 Perceptions of Stigmatization by Others for Seeking Help…………………………………………80 2.6.2.2 Stigma Scale for Receiving Psychological Help………...81 2.6.2.3 The Self-Stigma of Mental Illness Scale…,,,……………82 2.6.2.4 Perceived Devaluation-Discrimination Scale……………83 2.6.3 Measures of Self-Stigma………………...……………………….84 2.6.3.1 Self-Stigma of Seeking Psychological Help…….……….84 2.6.3.2 Attitudes Toward Seeking Professional vi ii Psychological Help………………………………………85 2.7 Summary…………………………………………………………………87 3 Methodology 88 3.1 Introduction………………………………………………………………88 3.2 Overview of Method……………………………………………………..88 3.3 Research Design………………………………………………………….89 3.4 Description of Participants……………………………………………….91 3.5 Sampling Procedures…………………………………………………….92 3.6 Instrumentation………………..…………………………………………92 3.6.1 Public Stigma…………………………………………………….92 3.6.1.1 Community Attitudes Toward the Mentally Ill………….92 3.6.2 Perceived Public Stigma…………………………………………93 3.6.2.1 Perceptions of Stigmatization by Others for Seeking Help…………………………………………93 3.6.3 Self-Stigma………………………………………………………94 3.6.3.1 Attitudes Toward Seeking Professional Psychological Help……………..………………………..94 3.7 Variables…………………………………………………………………95 3.7.1 Demographic Variables………………………………………….95 3.7.2 Independent Variables……………………...……………………95 3.7.3 Dependent Variables……………………………………………..95 3.8 Procedures……………….……………………………………………….96 3.8.1 Personal Testimony………………………………………………98 ix 3.9 Statistical Hypothesis…………………………………………………….99 3.10 Data Analysis………………..………………………………………….100 3.11 Summary………………………………………………………………..102 4 Findings 103 4.1 Introduction……………………………………………………………..103 4.2 Sample / Participants……………………………………………………103 4.3 Descriptive Data………………...………………………………………107 4.4 Research Questions……………………………………………………..109 4.5 Summary………………………………………………………………..119 5 Discussion 120 5.1 Introduction……………….…………………………………………….120 5.2 Background and Study Findings………………………………………..120 5.3 Integrating Findings into the Literature……………...…………………137 5.4 Implications……………………………….…………………………….142 5.4.1 Counseling Center Staff………………………………………...142 5.4.2 Residence Life Staff…………………………………………….143 5.4.3 University Administrators………………………………………144 5.4.4 Future Research………………………...………………………145 5.5 Statement of Limitations………………………………………………..147 5.5.1 Threats to Internal Validity……………………………………..148 5.5.2 Threats to External Validity…………………………………….149 5.6 Summary………………………………………………………………..151 References 153 x