Reliability and validity of the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form

Abstract

We examined the reliability and validity of the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF), a widely cited measure of mental health treatment attitudes. Data from 296 college students and 389 primary care patients were analyzed. The ATSPPH-SF evidenced adequate internal consistency. Higher scores (indicating more positive treatment attitudes) were associated with less treatment-related stigma, and greater intentions to seek treatment in the future. No associations were found for mental health impairment or depression. The ATSPPH-SF was related to the recent use of mental health treatment and recent treatment intensity (i.e., visit counts); after controlling for demographic variables associated with treatment use, this relationship held in predicting previous use from non-use, but not visit counts. Factor-analytic findings demonstrated that a two-factor model (Openness to Seeking Treatment for Emotional Problems, and Value and Need in Seeking Treatment) represented the data well. Implications for future research on mental healthcare use correlates are discussed, as well as the need for enhancing peoples' attitudes toward treatment.

Introduction

Large-scale epidemiological studies have found robust correlates of mental healthcare use, such as female gender, younger age, divorced or separated relationship status, and diagnoses of mood, substance use and anxiety disorders (Parslow and Jorm, 2000, Kessler et al., 2005, Wang et al., 2005, Elhai et al., 2006a). However, less is known about the association between treatment attitudes and treatment use. Studying this association is important, because attitudes toward treatment have the potential to be mutable, in facilitating individuals' access to treatment (Bhugra and Hicks, 2004).

Numerous studies have examined attitudes toward using mental healthcare. The few studies examining associations between treatment attitudes and actual treatment use have revealed statistically significant positive associations, using samples of college students (Fischer and Farina, 1995, Cohen, 1999, Mackenzie et al., 2004), local community residents (Mackenzie et al., 2004), and the general population (Lin and Parikh, 1999). Among those studies reporting effect sizes, treatment attitudes have typically yielded at least “medium” effects (i.e., r > 0.30), which is consistent with the broader literature demonstrating substantial consistency between attitudes and behavior (Crano and Prislin, 2006). However, it should be noted that most of the above studies queried lifetime treatment use, but not recent treatment use or utilization intensity (i.e., visit counts), potentially neglecting interesting relationships with treatment attitudes.

Only one standardized instrument assessing mental health treatment attitudes has been both psychometrically examined and used in a sizeable number of studies, the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPH) (Fischer and Turner, 1970), and a subsequent modernized short form (ATSPPH-SF) (Fischer and Farina, 1995). Numerous studies have documented psychometric support for the ATSPPH (reviewed in Fischer and Farina, 1995), and more recently for the ATSPPH-SF (Fischer and Farina, 1995, Komiya et al., 2000, Constantine, 2002, Vogel et al., 2005). The only similar measures are rarely used in research. Furthermore, with the exception of the Willingness to Seek Help Questionnaire (Cohen, 1999), similar instruments assess constructs that are not focused on global treatment attitudes, including the Stigma Scale for Receiving Psychological Help (Komiya et al., 2000), and Thoughts About Psychotherapy Survey (Kushner and Sher, 1989). Finally, the original ATSPPH was modified by Mackenzie et al. (2004) and labeled the Inventory of Attitudes Toward Seeking Mental Health Services, but still lacks brevity (24 items), and is overshadowed by the number of studies using the ATSPPH-SF.

In fact, several important problems exist with treatment attitude instruments. First, little psychometric data are available for these measures. Second, the sparse psychometric data typically do not validate treatment attitudes against behaviorally-specific measures of mental healthcare use, and such measures are crucial in accurately inquiring about treatment use (Elhai et al., 2005). Third, while on a conceptual basis unfavorable treatment attitudes may be better explained by mental health problems (e.g., depression's hopelessness and pessimism), studies have rarely assessed whether the treatment attitude construct is redundant with psychopathology, yielding conflicting findings (Komiya et al., 2000, Vogel et al., 2005, Wrigley et al., 2005). Fourth, such instruments are often developed and validated exclusively with college students, possibly limiting generalizability. Thus, while the treatment attitude construct is important in mental health services research, we do not know how precise relevant assessment instruments are.

The aim of the present investigation was to test the reliability and validity of the ATSPPH-SF, the most relevant and widely used contemporary assessment of mental health treatment attitudes. We examined internal consistency, construct and criterion validity, replicating previous research with this instrument (Fischer and Farina, 1995, Komiya et al., 2000, Constantine, 2002, Vogel et al., 2005). We extended previous work by including a) behaviorally-specific items to accurately inquire about recent mental healthcare use and utilization intensity in testing the scale's criterion validity, and b) an examination of factor structure. We expected to find high reliability for the ATSPPH-SF, adequate construct validity, and positive associations with recent mental healthcare use.

We chose to test this instrument in two separate populations of individuals. First, we implemented a college student sample, since this population was used in developing the ATSPPH-SF (Fischer and Farina, 1995), and in studies using the instrument (Komiya et al., 2000, Vogel et al., 2005). Furthermore, college students have been extensively studied in predicting mental healthcare use, representing a population often having significant treatment needs (Oliver et al., 1999). However, given concerns that mental health treatment attitude instruments lack psychometric data from more representative community samples, we chose to additionally include a sample of healthcare users. Specifically, we sampled primary care medical patients, a population previously studied for mental healthcare use correlates (Simon et al., 1994, Elhai et al., 2006b), representing individuals who are not necessarily seeking mental healthcare but have sought professional medical assistance.