JMIR Publications

ABSTRACT

Background:

Prevalences of mental disorders are increasing worldwide. However, most people with mental health problems do not receive treatment. An important factor preventing individuals from seeking professional help is negative attitudes towards psychotherapeutic treatment. Although a positive shift in attitudes has been observed in recent years, there is still substantial stigma surrounding psychotherapeutic treatment. First studies have linked higher health literacy with more positive attitudes towards psychotherapy, but more research is needed in this area.

Objective:

The aim of this study was to examine how general and mental health literacy are associated with attitudes towards psychotherapeutic treatment in Germany. In addition, associations between sociodemographic factors, experience with psychotherapy and attitudes towards psychotherapy were explored.

Methods:

A large and representative online sample of N = 2000 individuals aged 16 years and older was recruited in Germany. Attitudes towards psychotherapy, general and mental health literacy were assessed using the Questionnaire on Attitudes towards Psychotherapeutic Treatment (QAPT) with two subscales (positive attitudes and non-acceptance of society), the European Health Literacy Survey instrument (HLS-EU-Q16) and the Mental Health Literacy tool for the Workplace (MHL-W-G). Associations between the questionnaire scales were assessed with Pearson correlations. In addition, basic sociodemographic information and information on personal and family experience with psychotherapy were collected. Pearson correlations (age), analyses of variance (level of education, subjective social status) and t-tests (experience with psychotherapy, gender, migration background) were used to analyzes how these relate to attitudes towards psychotherapy.

Results:

More favorable attitudes towards psychotherapy and lower perceived societal non-acceptance were found in those with higher general (r=0.14, P<.001; r=−0.32, P<.001, respectively) and mental health literacy (r=0.18, P<.001; r=−0.23, P<.001, respectively). Participants who have been treated for mental health problems (t(1260.12)=−10.40, P<.001, d=−0.49; t(1050.95)=3.06, P=.002, d=0.16) and who have relatives who have been treated (t(1912.06)=−5.66, P<.001, d=−0.26; t(1926)=4.77, P<.001, d=0.22) reported more positive attitudes and higher perceived societal acceptance than those without treatment experience. In terms of sociodemographic differences, female gender (t(1992)=−3.60, P<.001, d=−0.16), younger age (r =−0.11, P<.001), higher subjective social status (F(2,1991)=5.25, P=.005, η2=.005) and higher levels of education (F(2,1983)=22.27, P<.001, η2=.021) were associated with more positive attitudes towards psychotherapeutic treatment. Male gender (t(1994)=5.29, P<.001, d=0.24), younger age (r=−0.08, P<.001) and lower subjective social status (F(2,1993)=7.71, P<.001, η2=.008) were associated with higher perceived non-acceptance of psychotherapy.

Conclusions:

Positive associations between attitudes towards psychotherapy and both general and mental health literacy were delineated. Future studies should investigate whether targeted interventions directed at individuals with lower general and mental health literacy might also help to improve attitudes towards psychotherapeutic treatment and help-seeking behavior.