Self-Stigma but not Mental Health Literacy Predicts Attitudes toward Professional Help- Seeking in an Indonesian Community Sample

Background: Personal stigmatizing attitudes towards mental illness and mental health services are important barriers to active help-seeking, which is also influenced by other factors, such as mental health literacy (MHL), type of mental problems, and sociodemographic characteristics, including cultural background. As most research has been conducted in Western high-income countries, we examined whether MHL and anticipated self-stigma predicted attitudes towards professional help-seeking in a Southeast Asian lower-middle-income country Methods: Using convenience sampling through online advertisements, N=912 participants from Surabaya, Indonesia, filled in an online survey. Of these, which 887 (age 18-40 years, 38.8% male) were analyzed after exclusion of outliers (n = 25). Controlling for age, sex, education, and type of mental problems using two different vignettes (depression and schizophrenia), hierarchical multiple regression analyses were used to examine predictors of help-seeking attitudes after careful examination of the model assumptions. Results: Analyses identified self-stigma as the sole predictor of help-seeking attitudes, explaining 25% of the variance. The observed power of the model was 1.00. Conclusions: In line with reports on the strong mediating role of self-stigma between public stigma and outcome in collectivistic cultures such as the Indonesian culture, this finding emphasizes the importance of anti-stigma campaigns rather than educational campaigns about mental disorders in Indonesia. However, before their implementation, more in-depth research on the interplay of sociodemographic characteristics, MHL and attitudes assessed by culturally adapted instruments is needed to develop programs that adequately consider cultural values, meanings, and practices.