(PS5-28) Personal anxiety and depression stigma as mediators in the relationship between perceived barriers to treatment and lifetime mental health outpatient service and mediation use

Abstract Text: Anxiety and depression are highly prevalent and contribute to the global disease burden. However, despite advances in evidence-based treatments for anxiety and depression, like CBT, there are still barriers to accessing treatment. Perceived barriers and facilitators to treatment are also affected by mental health stigma. For example, negative beliefs about mental health may prevent people from recognizing the signs and symptoms of mental health conditions, creating a barrier to help-seeking. This study adds to existing literature by examining personal anxiety and depression stigma as a mediator in the relationship between perceived barriers to treatment and outpatient mental health service use or psychiatric medication use. Data for this study were collected as a part of a two-part parent study including diverse participants from Prolific (n = 308; 24% White, 21% Multiracial, 20% Asian; 51% Heterosexual, 22% Bisexual; 72% Cisgender) and from a public university (n = 148; 58% White, 20% Multiracial, 8% Latine; 52% Heterosexual, 18% Bisexual; 74% Cisgender). All participants completed questionnaires assessing personal anxiety and depression stigma, perceived barriers to treatment (e.g., cost, feeling ashamed), and lifetime use of mental health services. Questionnaire scores indicated that participants generally had low levels of anxiety stigma (M= 4.86, SD = 5.92) and depression stigma (M = 6.71, SD = 5.31) and encountered an average of five barriers to treatment (M = 4.99, SD = 3.48). About half of participants used outpatient services (54%) or psychiatric medication (49%). Bootstrapped mediation analyses with 500 resamples demonstrated that anxiety stigma did not significantly mediate the relationship between perceived barriers to treatment and outpatient service use (ACME = 0.002, 95% CI [-0.0005, 0], p = .14). However, anxiety stigma significantly mediated the relationship between perceived barriers to treatment and medication use (ACME = 0.003, 95% CI [0.0006, 0.1], p < .001). Bootstrapped mediation analyses with 500 resamples for depression stigma revealed that depression stigma significantly mediated the relationship between perceived barriers to treatment and outpatient service use (ACME = 0.003, 95% CI [0.0003, 0.1], p < .05), as well as the relationship between perceived barriers to treatment and medication use (ACME = 0.005, 95% CI [0.002, 0.1], p < .001). The significant mediation effect of personal anxiety stigma suggests that greater perceived barriers to treatment predicts lower levels of stigma, which partially predicts higher use of outpatient services. Additionally, the significant mediation effects of personal depression stigma suggest that greater perceived barriers to treatment predict lower levels of stigma, which partially predict higher use of outpatient services and psychiatric medication use. These findings suggest that addressing personal stigma may provide a pathway to increase the use of mental health services. Providers and mental health care systems should work to address perceived barriers to treatment and personal stigma, for example, by increasing public education on mental health through the dissemination of CBT resources.