Adolescence, emotional and behavioral problems, and counseling : where's the stigma? PDF
Preview Adolescence, emotional and behavioral problems, and counseling : where's the stigma?
ADOLESCENCE,EMOTIONALANDBEHAVIORALPROBLEMS,AND COUNSELING:WHERE'STHESTIGMA? By CAROLINEELDERDANDA ADISSERTATIONPRESENTEDTOTHEGRADUATESCHOOL OFTHEUNIVERSITYOFFLORIDAINPARTIALFULFILLMENT OFTHEREQUIREMENTSFORTHEDEGREEOF DOCTOROFPHILOSOPHY UNIVERSITYOFFLORIDA 2002 ACKNOWLEDGMENTS Therearemanypeoplewhocontributedtothesuccessfulcompletionofthis project.Iwouldliketothankmycommitteemembers,withspecialthankstomycochair SuzanneBennettJohnsonforherenthusiasmandinsightandforbeinganexcellentrole model.SpecialrecognitiongoestomychairGarretEvans,whoseencouragement, thoughtfulguidance,andconfidenceinmethroughoutgraduateschoolandthisproject havebeeninstrumentalindevelopingmyidentityasaresearcherandclinician. DatacollectionwouldnothavebeenpossiblewithoutthecooperationofGloria Spiveyaswellasthestaff,teachers,andstudentsatColumbiaHighSchool.Additional recognitiongoestotheteamofpeoplewhohelpedwithdatacollectionand/ordataentry, includingAmyBaughcum,KimKirkpacktrickJustice,RebeccaKristal,RachelNitzberg, AbbySia,JessicaStilley,andBrendaWiens. Iwouldalsoliketoexpressmygratitudetomygoodfriendandcolleague,Beth Bryant.Together,weweatheredmanystormsandcelebratedmanymilestones.Thanks alsogotomyparents,whotoldmeIcouldachieveanythingthatIwantedifIworked hardenoughandsupportedmydecisiontoenterthefieldofpsychology.Last,butmost certainlynotleast,Ithankmyhusbandandbestfriend,Matt,whounconditionally supportedandencouragedmethroughthestressofthedissertationandgraduateschool andwaswillingtomakethesacrificesthatareaninherentpartofbeingaspouseof someonegoingthroughtheseprocesses. 11 TABLEOFCONTENTS page ACKNOWLEDGMENTS " LISTOFTABLES V LISTOFFIGURES vii ABSTRACT viii INTRODUCTION 1 PrevalenceofMentalDisorderinChildren 1 ServiceUtilization 2 AttitudesTowardMentalIllness 8 AttitudesTowardCounseling/Therapy 12 CONCEPTUALBASESFORTHECURRENTSTUDY 19 Stigma 19 Attitudes 20 VignetteMethodology 21 PURPOSEOFTHESTUDY 23 ResearchQuestions 23 Hypotheses 24 METHOD 31 ExperimentalConditions 31 Procedure 37 Participants 39 ANALYSISPLAN 42 in RESULTS 45 DataInspection 45 PrimaryANOVAAnalyses 49 SecondaryANOVAAnalyses 56 DISCUSSION 75 APPENDIXA VIGNETTEDESCRIPTIONS 97 APPENDIXB ADJECTIVECHECKLIST 99 APPENDIXC ORIGINALACTIVITYPREFENCELIST 100 APPENDIXD ADOLESCENTACTIVITYPREFERENCELIST 101 APPENDIXE MANIPULATIONCHECKQUESTIONS 102 APPENDIXF HELPSEEKINGSCALE 103 APPENDIXG LETTERTOPARENTS 106 APPENDIXH COVERLETTERTOADOLESCENT 107 APPENDIXI DEBRIEFINGSTATEMENT 108 LISTOFREFERENCES 109 BIOGRAPHICALSKETCH 117 IV LISTOFTABLES Table Page 1. DemographicCharacteristicsofParticipants(N=442) 41 2. SubjectDistributionacrossExperimentalConditions 41 3. MeansandStandardDeviationsacrossExperimentalConditionsontheAdjective Checklist(N=434) 63 4. MeansandStandardDeviationsacrossExperimentalConditionsonthe AdolescentActivityPreferenceList(N=433) 63 5. RespondentCharacteristicsofParticipantsAcrossGender(N=442) 64 6. MeansontheAdjectiveChecklistandAdolescentActivityPreferenceListfor EmotionalandBehavioralProblemsMainEffect 64 7. EstimatedMarginalMeansontheAdjectiveChecklistforEmotionaland BehavioralProblemsxCounselingStatusInteraction 66 8. EstimatedMarginalMeansontheAdjectiveChecklistforEmotionaland BehavioralProblemsxGenderInteraction 67 9. EstimatedMarginalMeansontheAdolescentActivityPreferenceListfor EmotionalandBehavioralProblemsxGenderxPriorCounselingExperience Interaction 69 10. EstimatedMarginalMeansontheAdjectiveChecklistforEmotionaland BehavioralProblemsxCounselingStatusxPerceivedSimilarityInteraction...70 11. EstimatedMarginalMeansontheAdolescentActivityPreferenceListfor EmotionalandBehavioralProblemsxGenderxPerceivedSimilarity Interaction 71 12. EstimatedMarginalMeansontheAdolescentActivityPreferenceListfor EthnicityxEmotionalandBehavioralProblemsInteraction 72 13. EstimatedMarginalMeansontheAdjectiveChecklistforCounselingStatusx GenderxGradeInteraction 73 14. EstimatedMarginalMeansontheAdjectiveChecklistforRuralityxCounseling StatusInteraction 74 VI LISTOFFIGURES Figure Page 1. MainEffectofEmotionalandBehavioralProblemsontheAdjectiveChecklist 65 2. MainEffectforEmotionalandBehavioralProblemsontheAdolescentActivity PreferenceList 65 3. InteractionEffectforEmotionalandBehavioralProblemsxCounselingStatuson theAdjectiveChecklist 66 4. InteractionEffectforEmotionalandBehavioralProblemsxGenderonthe AdjectiveChecklist 67 5. InteractionEffectforEmotionalandBehavioralProblemsxCounselingStatusx GenderontheAdjectiveChecklist(seeTable3forMeans) 68 6. InteractionEffectforEmotionalandBehavioralProblemsxPriorCounseling ExperiencexGenderontheAdolescentActivityPreferenceList 69 7. InteractionEffectforPerceivedSimilarityxEmotionalandBehavioralProblems xGenderontheAdjectiveChecklist 70 8. InteractionEffectforPerceivedSimilarityxEmotionalandBehavioralProblems xGenderontheAdolescentActivityPreferenceList 71 9. InteractionEffectforEthnicityxEmotionalandBehavioralProblemsonthe AdolescentActivityPreferenceList 72 10. InteractionEffectforRuralityxCounselingStatusontheAdjectiveChecklist 74 vn AbstractofDissertationPresentedtotheGraduateSchool oftheUniversityofFloridainPartialFulfillmentofthe RequirementsfortheDegreeofDoctorofPhilosophy ADOLESCENCE,EMOTIONALANDBEHAVIORALPROBLEMS,AND COUNSELING:WHERE'STHESTIGMA? By CarolineElderDanda August2002 Chair:GarretD.Evans Cochair:SuzanneBennettJohnson MajorDepartment:ClinicalandHealthPsychology Usingavignettemethodology,thisstudyexaminedadolescentattitudestoward commonemotionalandbehavioralproblemsandschool-basedcounselingwithinarural community.Participantsincluded442highschoolstudentsfromruralFlorida.Peers describedasexhibitingbehaviorsassociatedwithdepression,familyconflict,and conductdisorderwereconsistentlyratedlessfavorablythanpeerswithoutanyproblems, withparticularlystrongeffectsforconductdisorder.Stigma(i.e.,negativeattitudes) attachedtoemotionalandbehavioralproblemsappearedstrongerthanthestigma attachedtocounseling.Althoughpeerswithoutapparentpsychologicalproblemswere ratedlessfavorablyiftheyattendedcounseling,theywerestillratedsignificantlymore favorablythanpeerswithproblems,regardlessoftheircounselingstatus.Gender, rurality,perceivedsimilarity,priorcounselingexperience,andethnicitymoderatedsome oftheeffectsrelatedtoemotionalandbehavioralproblemsandcounselingstatus.For vin example,adolescentscharacterizingthemselvesaslivinginthecountryratedpeerswho attendedcounselinglessfavorablythanthoselivingintown,whichsuggeststhat adolescentslivinginthecountrymaybelesstolerantorunderstandingofpeerswho attendcounseling.Malesandfemalesalsohadsignificantlystrongerandopposite reactionstotheirsame-sexpeerswithdepression.Femalesviewedtheirsame-sexpeers withdepressionincounselingmostpositively,andmalesviewedtheirsame-sexpeers withdepressionlesspositivelycomparedtothosewithfamilyconflictbutnotconduct disorder. Thisstudyindicatedthatthemanifestationsofemotionalandbehavioralproblems seemtoimpactattitudesmorethancounseling,perse.Consequently,themessagethat counselingcanhelpameliorateemotionalandbehavioralproblemsthatmightalreadybe negativelyimpactingsocialrelationships,andseemstohavelittleadditionalnegative effectswithrespecttoadolescentattitudes,canhelpallayadolescentandparental concernsabouttheirchildrenattendingcounselingwithapsychologist.Educationabout thenatureandprevalenceofcommonemotionalandbehavioralproblemsaswellasthe effectivenessofcounselinginaddressingtheseproblemsshouldbeanintegralpartofany school-basedmentalhealthprograminordertofostermoreopendiscussionofmental healthissues,andperhapsleadtolessstigmatizationandmoresupportamongthepeer group. IX INTRODUCTION PrevalenceofMentalDisorderinChildren Estimatesofadolescentemotionalandbehavioraldifficultiesrangefrom11-22% (Cohen&Hesselbart,1993;Kashanietal.,1987;Offordetal.,1987;Whitakeretal., 1990).Emotionaldisturbancesbegintooccuratincreasedratesinadolescence (Achenbach,Howell,Quay,&Conners,1991;Dubow,Lovko,&Kausch,1990;Offer& SchonertReichl,1992),withdepression,eatingdisorders,familyconflict,conduct disorder,andsubstanceabuseamongthemostfrequentlyreportedproblems(Anglin, Naylor,&Kaplan,1996;Dubowetal.,1990;Kashanietal.,1987;Whitakeretal.,1990). EstimatesfromtheOfficeofTechnologyAssessment(1991)furthersuggestthat18-22% ofadolescentshaveemotionaldisordersthatwarrantintervention. Withrespecttogender,overallprevalenceratesofemotionalandbehavioral problemsarerelativelyequal.Althoughmalestendtohavehigherprevalenceratesof disorderinchildhood,femalesevidenceincreasedsymptomatologyanddistress(e.g., emotionaldisorders)duringadolescence,leadingtocomparableprevalenceratesbetween thesexesduringtheadolescentyears(Dubowetal.,1990;Offordetal.,1987).However, maleandfemaleprevalenceratesdifferbytypeofdisorder.Adolescentmalestendto exhibitmoreexternalizingdifficulties(e.g.,behaviordisordersandsubstanceabuse) whereasadolescentfemalesexhibitmoreinternalizingdifficulties(e.g.,eatingdisorders, dysthymia,anddepression)(Ostrov,Offer,&Howard,1989;Whitakeretal.,1990).
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